Provider Demographics
NPI:1568496628
Name:BROOKWOOD CENTER DEVELOPMENT CORPORATION
Entity Type:Organization
Organization Name:BROOKWOOD CENTER DEVELOPMENT CORPORATION
Other - Org Name:BROOKWOOD CENTER FOR DEVELOPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF GOVT PROGRAMS, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:C
Authorized Official - Last Name:ARMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-775-8043
Mailing Address - Street 1:PO BOX 740799
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-0799
Mailing Address - Country:US
Mailing Address - Phone:205-877-2453
Mailing Address - Fax:205-871-0534
Practice Address - Street 1:513 BROOKWOOD BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6878
Practice Address - Country:US
Practice Address - Phone:205-877-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROOKWOOD CENTER DEVELOPMENT CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-11
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11009261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000055369BROMedicare PIN