Provider Demographics
NPI:1235251810
Name:PHYSICIANS MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:PHYSICIANS MEDICAL CENTER, LLC
Other - Org Name:PHYSICIANS-CARRAWAY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1223
Mailing Address - Street 1:PO BOX 830469
Mailing Address - Street 2:MSC 511
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35283-0469
Mailing Address - Country:US
Mailing Address - Phone:205-979-8552
Mailing Address - Fax:205-979-1248
Practice Address - Street 1:1600 CARRAWAY BLVD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35234-1913
Practice Address - Country:US
Practice Address - Phone:205-502-6000
Practice Address - Fax:205-502-5720
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSICIANS MEDICAL CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-04
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1300X, 367500000X
ALH3703282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529932815Medicaid
AL529932340Medicaid
AL529932814Medicaid
AL529932814Medicaid