Provider Demographics
NPI:1801845243
Name:BIRMINGHAM NEUROSURGERY & SPINE GROUP PC
Entity Type:Organization
Organization Name:BIRMINGHAM NEUROSURGERY & SPINE GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CARVEL
Authorized Official - Last Name:WOODALL
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:205-986-5200
Mailing Address - Street 1:3125 INDEPENDENCE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-4164
Mailing Address - Country:US
Mailing Address - Phone:205-986-5200
Mailing Address - Fax:205-986-5250
Practice Address - Street 1:3125 INDEPENDENCE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-4164
Practice Address - Country:US
Practice Address - Phone:205-986-5200
Practice Address - Fax:205-986-5250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
374211700OtherUS DEPT OF LABOR
AL529100210Medicaid
ALI461Medicare ID - Type Unspecified
AL529100210Medicaid
CI6795Medicare PIN
374211700OtherUS DEPT OF LABOR