Provider Demographics
NPI:1639501976
Name:BIO-IDENTICAL HORMONES OF HUNTSVILLE
Entity Type:Organization
Organization Name:BIO-IDENTICAL HORMONES OF HUNTSVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MASON
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-715-8780
Mailing Address - Street 1:3601 MEMORIAL PKWY SW
Mailing Address - Street 2:SUITE C
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5397
Mailing Address - Country:US
Mailing Address - Phone:256-715-8780
Mailing Address - Fax:256-715-8769
Practice Address - Street 1:3601 MEMORIAL PKWY SW
Practice Address - Street 2:SUITE C
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5397
Practice Address - Country:US
Practice Address - Phone:256-715-8780
Practice Address - Fax:256-715-8769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17161261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center