Provider Demographics
NPI:1922068774
Name:BIRMINGHAM SURGICAL, P.C.
Entity Type:Organization
Organization Name:BIRMINGHAM SURGICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:DEREK
Authorized Official - Last Name:LASKER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:205-877-2910
Mailing Address - Street 1:2022 BROOKWOOD MEDICAL CTR DR
Mailing Address - Street 2:SUITE 313 ACC
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6808
Mailing Address - Country:US
Mailing Address - Phone:205-877-2910
Mailing Address - Fax:205-879-4649
Practice Address - Street 1:2022 BROOKWOOD MEDICAL CTR DR
Practice Address - Street 2:SUITE 313 ACC
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6808
Practice Address - Country:US
Practice Address - Phone:205-877-2910
Practice Address - Fax:205-879-4649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC321OtherBROUP BILLING BLUE CROSS
AL1043279797OtherNPI
AL1457311250OtherNPI
AL528500610Medicaid
AL1750341756OtherNPI
1922068774OtherGROUP NPI
AL1306805825OtherNPI
AL1326008129OtherNPI
AL1780644591OtherNPI
CM7410OtherGROUP RAILROAD MEDICARE
AL528500610Medicaid