Provider Demographics
NPI:1376769976
Name:NORWOOD CLINIC, INC.
Entity Type:Organization
Organization Name:NORWOOD CLINIC, INC.
Other - Org Name:WARRIOR FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE OFFICE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-250-6846
Mailing Address - Street 1:PO BOX 830230
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35283-0230
Mailing Address - Country:US
Mailing Address - Phone:205-250-6846
Mailing Address - Fax:205-250-6411
Practice Address - Street 1:151 5TH ST E
Practice Address - Street 2:
Practice Address - City:WARRIOR
Practice Address - State:AL
Practice Address - Zip Code:35180-1352
Practice Address - Country:US
Practice Address - Phone:205-647-0526
Practice Address - Fax:205-647-0527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALD456OtherGROUP PTAN #
ALD456OtherGROUP PTAN #
ALG20296Medicare UPIN