Provider Demographics
NPI:1508976598
Name:NORTH SHELBY FAMILY HEALTH
Entity Type:Organization
Organization Name:NORTH SHELBY FAMILY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-980-9944
Mailing Address - Street 1:2520 VALLEYDALE RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-2019
Mailing Address - Country:US
Mailing Address - Phone:205-980-9944
Mailing Address - Fax:205-980-9844
Practice Address - Street 1:2520 VALLEYDALE RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-2019
Practice Address - Country:US
Practice Address - Phone:205-980-9944
Practice Address - Fax:205-980-9844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529700260Medicaid
AL000033061Medicare ID - Type UnspecifiedDR. DOUGLAS O MOORE
AL000033062Medicare ID - Type UnspecifiedDR. VANCEBLACKBURN
ALC72627Medicare UPIN
6443740001Medicare NSC
AL529700260Medicaid