Provider Demographics
NPI:1164899878
Name:THCP BHAM AL 1 LLC
Entity Type:Organization
Organization Name:THCP BHAM AL 1 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BURBAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-525-1069
Mailing Address - Street 1:3829 LORNA RD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-7034
Mailing Address - Country:US
Mailing Address - Phone:949-525-1069
Mailing Address - Fax:
Practice Address - Street 1:3829 LORNA RD
Practice Address - Street 2:SUITE 312
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-7034
Practice Address - Country:US
Practice Address - Phone:949-525-1069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-28
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty