Provider Demographics
NPI:1932298718
Name:OUTPATIENT SERVICES EAST
Entity Type:Organization
Organization Name:OUTPATIENT SERVICES EAST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:STIDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-838-3888
Mailing Address - Street 1:52 MEDICAL PARK DRIVE EAST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235
Mailing Address - Country:US
Mailing Address - Phone:205-838-3888
Mailing Address - Fax:205-838-3875
Practice Address - Street 1:52 MEDICAL PARK DRIVE EAST
Practice Address - Street 2:SUITE 401
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235
Practice Address - Country:US
Practice Address - Phone:205-838-3888
Practice Address - Fax:205-838-3875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL311OtherBLUE CROSS
ALASC0006CMedicaid