Provider Demographics
NPI:1891837936
Name:BROOKWOOD MEDICAL GROUP, P. C.
Entity Type:Organization
Organization Name:BROOKWOOD MEDICAL GROUP, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:ROBERTS
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-877-2900
Mailing Address - Street 1:2018 BROOKWOOD MEDICAL CTR DR
Mailing Address - Street 2:SUITE G-5 PROFESSIONAL BUILDING
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6898
Mailing Address - Country:US
Mailing Address - Phone:205-877-2900
Mailing Address - Fax:205-877-2904
Practice Address - Street 1:2018 BROOKWOOD MEDICAL CTR DR
Practice Address - Street 2:SUITE G-5 PROFESSIONAL BUILDING
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6898
Practice Address - Country:US
Practice Address - Phone:205-877-2900
Practice Address - Fax:205-877-2904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3558207R00000X
AL8361207R00000X
AL15045207R00000X
AL24915207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC73055Medicare UPIN
ALH76494Medicare UPIN
ALE47609Medicare UPIN
ALC73579Medicare UPIN
ALD494Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER