Provider Demographics
NPI:1497957500
Name:PODIATRY ASSOCIATES PC
Entity Type:Organization
Organization Name:PODIATRY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:I
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:205-933-9595
Mailing Address - Street 1:1717 11TH AVE SOUTH
Mailing Address - Street 2:SUITE 402
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-4731
Mailing Address - Country:US
Mailing Address - Phone:205-933-9595
Mailing Address - Fax:205-933-5250
Practice Address - Street 1:1717 11TH AVE SOUTH
Practice Address - Street 2:SUITE 402
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-4731
Practice Address - Country:US
Practice Address - Phone:205-933-9595
Practice Address - Fax:205-933-5250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL94213ES0131X
AL124213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1201219OtherUHC RUSSELL
AL697685OtherUHC GROUP
AL968248OtherUHC BOWMAN
AL1245228667Medicare PIN
AL0286530001Medicare NSC
AL968248OtherUHC BOWMAN
AL000070985Medicare PIN
AL000008463Medicare PIN
AL697685OtherUHC GROUP
AL1497957500Medicare UPIN
ALU19320Medicare UPIN
AL480028194Medicare PIN
AL480014276Medicare PIN
ALD447Medicare PIN