Provider Demographics
NPI:1336507953
Name:BIRMINGHAM AIDS OUTREACH
Entity Type:Organization
Organization Name:BIRMINGHAM AIDS OUTREACH
Other - Org Name:MAGIC CITY WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-877-8677
Mailing Address - Street 1:3220 5TH AVE S STE 100
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35222-2309
Mailing Address - Country:US
Mailing Address - Phone:205-877-8677
Mailing Address - Fax:205-877-8675
Practice Address - Street 1:3220 5TH AVE S STE 100
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35222-2309
Practice Address - Country:US
Practice Address - Phone:205-877-8677
Practice Address - Fax:205-877-8675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-10
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL075108261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALH01461Medicare UPIN