Provider Demographics
NPI:1619912425
Name:MEDICAL ASSOCIATES OF BIRMINGHAM PC
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES OF BIRMINGHAM PC
Other - Org Name:KING AND RICHARDSON PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:P
Authorized Official - Last Name:O'SHIELDS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:205-599-3000
Mailing Address - Street 1:4229 SHARPSBURG DR.
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213
Mailing Address - Country:US
Mailing Address - Phone:205-599-3000
Mailing Address - Fax:205-599-4910
Practice Address - Street 1:810 ST. VINCENT'S DR.
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205
Practice Address - Country:US
Practice Address - Phone:205-939-2000
Practice Address - Fax:205-599-4910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
AL12818207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529908460Medicaid
AL529908460Medicaid