Provider Demographics
NPI:1396833927
Name:MCARDLE, PHILIP
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:MCARDLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1717 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1801
Practice Address - Country:US
Practice Address - Phone:800-822-8816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19020207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051511205OtherBLUE CROSS
AL000025455Medicaid
AL010033CG03078OtherSECTION 1011
AL009939906Medicaid
AL051025455OtherBLUE CROSS
AL051035983OtherBLUE CROSS
MS00117169Medicaid
AL050038942OtherRAILROAD MEDICARE
AL051537691OtherBLUE CROSS
LA1413623Medicaid
ALG03078OtherVIVA
LA05701OtherBLUE CROSS
AL3545OtherHEALTHSPRING
AL000035983Medicare ID - Type Unspecified
AL000025455Medicaid