Provider Demographics
NPI:1245378645
Name:ALDRIDGE & KEITH, P.C.
Entity Type:Organization
Organization Name:ALDRIDGE & KEITH, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:LATHRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-766-5762
Mailing Address - Street 1:PO BOX 897
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35631-0897
Mailing Address - Country:US
Mailing Address - Phone:256-766-5762
Mailing Address - Fax:256-740-8842
Practice Address - Street 1:1100 S JACKSON HWY
Practice Address - Street 2:SUITE 259
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-5769
Practice Address - Country:US
Practice Address - Phone:256-766-5762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C74742Medicare UPIN
F54989Medicare UPIN
Q22536Medicare UPIN
G66281Medicare UPIN