Provider Demographics
NPI:1407197445
Name:TLM OBSTETRICS, GYNECOLOGY AND WOMENS HEALTHCARE OF WEST CENTRAL ALABA
Entity Type:Organization
Organization Name:TLM OBSTETRICS, GYNECOLOGY AND WOMENS HEALTHCARE OF WEST CENTRAL ALABA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:ESTHER
Authorized Official - Last Name:HILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-875-7173
Mailing Address - Street 1:1023 MEDICAL CENTER PKWY
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-6780
Mailing Address - Country:US
Mailing Address - Phone:334-875-7173
Mailing Address - Fax:866-890-6112
Practice Address - Street 1:1023 MEDICAL CENTER PKWY
Practice Address - Street 2:SUITE 401
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-6780
Practice Address - Country:US
Practice Address - Phone:334-875-7173
Practice Address - Fax:866-890-6112
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TLM HEADQUARTERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL28410207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALST00991228Medicaid
ALB69183Medicare UPIN
ALST00991228Medicaid