Provider Demographics
NPI:1376603274
Name:CENTRAL ALABAMA INTERNAL MEDICINE ASSOCIATES PA
Entity Type:Organization
Organization Name:CENTRAL ALABAMA INTERNAL MEDICINE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WINSTON
Authorized Official - Middle Name:TACKER
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-288-8405
Mailing Address - Street 1:2055 EAST SOUTH BLVD
Mailing Address - Street 2:SUITE 512
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-2014
Mailing Address - Country:US
Mailing Address - Phone:334-288-8405
Mailing Address - Fax:334-284-2271
Practice Address - Street 1:2055 EAST SOUTH BLVD
Practice Address - Street 2:SUITE 512
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-2014
Practice Address - Country:US
Practice Address - Phone:334-288-8405
Practice Address - Fax:334-284-2271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CJ3376OtherRAILROAD MEDICARE
D435Medicare ID - Type Unspecified