Provider Demographics
NPI:1639753171
Name:IMC -GULF ORTHOPAEDICS LLC
Entity Type:Organization
Organization Name:IMC -GULF ORTHOPAEDICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:PALAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-435-1361
Mailing Address - Street 1:1720 SPRING HILL AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604-1410
Mailing Address - Country:US
Mailing Address - Phone:251-435-1164
Mailing Address - Fax:251-435-1616
Practice Address - Street 1:1720 SPRING HILL AVE FL 3
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-1410
Practice Address - Country:US
Practice Address - Phone:251-435-1164
Practice Address - Fax:251-435-1616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-11
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty