Provider Demographics
NPI:1508817198
Name:DARRELL S. PRESTRIDGE, DO, PC
Entity Type:Organization
Organization Name:DARRELL S. PRESTRIDGE, DO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:S
Authorized Official - Last Name:PRESTRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-621-3437
Mailing Address - Street 1:PO BOX 531326
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35253-1326
Mailing Address - Country:US
Mailing Address - Phone:205-621-3437
Mailing Address - Fax:205-621-8550
Practice Address - Street 1:2122 OLD MONTGOMERY HWY
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-1138
Practice Address - Country:US
Practice Address - Phone:205-621-3437
Practice Address - Fax:205-621-8550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529927780Medicaid
ALDE6484OtherRAILROAD MEDICARE GROUP #
AL529927780Medicaid
ALG58319Medicare UPIN