Provider Demographics
NPI:1699179440
Name:ALABAMA REGIONAL MEDICAL SERVICES
Entity Type:Organization
Organization Name:ALABAMA REGIONAL MEDICAL SERVICES
Other - Org Name:ENSLEY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-212-5654
Mailing Address - Street 1:PO BOX 11523
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35202-1523
Mailing Address - Country:US
Mailing Address - Phone:205-212-5600
Mailing Address - Fax:205-212-5660
Practice Address - Street 1:417 19TH STREET ENSLEY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35218-1601
Practice Address - Country:US
Practice Address - Phone:205-783-9300
Practice Address - Fax:205-783-9305
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALABAMA REGIONAL MEDICAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-22
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty