Provider Demographics
NPI:1639237936
Name:ORTHOPEDIC GROUP OF BIRMINGHAM,P.C.
Entity Type:Organization
Organization Name:ORTHOPEDIC GROUP OF BIRMINGHAM,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:ELKUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-939-0610
Mailing Address - Street 1:1400 SOUTH 19TH STREET
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205
Mailing Address - Country:US
Mailing Address - Phone:205-939-0610
Mailing Address - Fax:205-930-9134
Practice Address - Street 1:1400 SOUTH 19TH STREET
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205
Practice Address - Country:US
Practice Address - Phone:205-939-0610
Practice Address - Fax:205-930-9134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00024049207X00000X, 207XS0114X, 207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Single Specialty
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic TraumaGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALEL009926035Medicaid
AL51553670OtherBLUE CROSS- BLUE SHIELD
AL51553670OtherBLUE CROSS- BLUE SHIELD
ALH84359Medicare UPIN
ALEL009926035Medicaid