Provider Demographics
NPI:1528204724
Name:ALABAMA REGIONAL MEDICAL SERVICES
Entity Type:Organization
Organization Name:ALABAMA REGIONAL MEDICAL SERVICES
Other - Org Name:BIRMINGHAM HEALTH CARE - MEDICAL PLAZA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-212-5654
Mailing Address - Street 1:P.O. BOX 11523
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 20TH ST S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-4998
Practice Address - Country:US
Practice Address - Phone:205-212-5600
Practice Address - Fax:205-212-5660
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALABAMA REGIONAL MEDICAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-18
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL630009016Medicaid