Provider Demographics
NPI:1629089701
Name:ALABAMA HEAD AND NECK CLINIC
Entity Type:Organization
Organization Name:ALABAMA HEAD AND NECK CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:CACERES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-424-1450
Mailing Address - Street 1:PO BOX 1445
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35021-1445
Mailing Address - Country:US
Mailing Address - Phone:205-424-1450
Mailing Address - Fax:205-424-6077
Practice Address - Street 1:730 MEMORIAL DR
Practice Address - Street 2:SUITE 108
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-6032
Practice Address - Country:US
Practice Address - Phone:205-424-1450
Practice Address - Fax:205-424-6077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
AL572-A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL528200800Medicaid
ALK930Medicare PIN