Provider Demographics
NPI:1477695013
Name:BIRMINGHAM PODIATRY PC
Entity Type:Organization
Organization Name:BIRMINGHAM PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROBERSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:205-324-8511
Mailing Address - Street 1:805 ST. VINCENT'S DRIVE
Mailing Address - Street 2:SUITE 420
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205
Mailing Address - Country:US
Mailing Address - Phone:205-324-8511
Mailing Address - Fax:205-324-0319
Practice Address - Street 1:805 ST. VINCENT'S DRIVE
Practice Address - Street 2:SUITE 420
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-2704
Practice Address - Country:US
Practice Address - Phone:205-324-8511
Practice Address - Fax:205-324-0319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
051514505OtherBLUE CROSS
AL051598947OtherBLUE CROSS
AL000070338Medicaid
051070338OtherBLUE CROSS
051070353OtherBLUE CROSS
AL000070353Medicaid
AL000070942Medicaid
051070942OtherBLUE CROSS
AL890009900Medicaid
AL1174562755Medicaid
T68878Medicare UPIN
T68870Medicare UPIN
051514505OtherBLUE CROSS
AL000070353Medicaid
AL1174562755Medicaid
AL000070338Medicare PIN
051070942OtherBLUE CROSS
AL000070942Medicare PIN
AL000070353Medicare PIN
AL890009900Medicaid
AL000070942Medicaid