Provider Demographics
NPI:1942489232
Name:PODIATRY ASSOCIATES PC
Entity Type:Organization
Organization Name:PODIATRY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:I
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:256-249-2212
Mailing Address - Street 1:1717 11TH AVE SOUTH
Mailing Address - Street 2:SUITE 402
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-4731
Mailing Address - Country:US
Mailing Address - Phone:205-933-9595
Mailing Address - Fax:205-933-5250
Practice Address - Street 1:401 WEST 3RD STREET
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-1916
Practice Address - Country:US
Practice Address - Phone:256-249-2212
Practice Address - Fax:205-933-5250
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PODIATRY ASSOCIATES PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-02
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL124213ES0131X
AL94213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000072719Medicare PIN
AL000008462Medicare PIN
AL1245228667Medicare PIN
AL1942489232Medicare UPIN
ALU19320Medicare UPIN
AL480014276Medicare PIN
ALT68895Medicare UPIN
ALD447Medicare PIN
AL0286530005Medicare NSC
AL1265420673Medicare PIN
AL480028194Medicare PIN