Provider Demographics
NPI:1326220351
Name:EAST ALABAMA ARTHRITIS CENTER PC
Entity Type:Organization
Organization Name:EAST ALABAMA ARTHRITIS CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-501-4424
Mailing Address - Street 1:1536 PROFESSIONAL PKWY
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-2857
Mailing Address - Country:US
Mailing Address - Phone:334-501-4424
Mailing Address - Fax:334-501-1223
Practice Address - Street 1:1536 PROFESSIONAL PKWY
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-2857
Practice Address - Country:US
Practice Address - Phone:334-501-4424
Practice Address - Fax:334-501-1223
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST ALABAMA ARTHRITIS CENTER PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-30
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00023033261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529906060Medicaid
AL009943130Medicaid
AL51098534OtherBLUE CROSS BLUE SHIELD
ALJ424Medicare PIN
ALG34292Medicare UPIN
AL3899450001Medicare NSC