Provider Demographics
NPI:1508856352
Name:EICH PLASTIC SURGERY PC
Entity Type:Organization
Organization Name:EICH PLASTIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:SHELBY
Authorized Official - Last Name:EICH
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:205-856-6155
Mailing Address - Street 1:200 PILOT MEDICAL DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3462
Mailing Address - Country:US
Mailing Address - Phone:205-856-6155
Mailing Address - Fax:205-856-9391
Practice Address - Street 1:200 PILOT MEDICAL DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3462
Practice Address - Country:US
Practice Address - Phone:205-856-6155
Practice Address - Fax:205-856-9391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17710208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009975650Medicaid
F78813OtherVIVA
43438OtherTHE OATH
51505077OtherBC
1310081OtherUNITED HEALTH CARE
51505077OtherBC
43438OtherTHE OATH