Provider Demographics
NPI:1508887738
Name:ACIPCO MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:ACIPCO MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:W
Authorized Official - Last Name:PITTS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:205-325-7001
Mailing Address - Street 1:PO BOX 12725
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35202-6725
Mailing Address - Country:US
Mailing Address - Phone:205-325-7001
Mailing Address - Fax:205-325-1976
Practice Address - Street 1:3200 16TH ST N
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35207-4202
Practice Address - Country:US
Practice Address - Phone:205-325-7001
Practice Address - Fax:205-325-1976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL06023933207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALK734Medicare ID - Type Unspecified