Provider Demographics
NPI:1982842472
Name:ADVANCED ARTHRITIS CARE AT SHELBY
Entity Type:Organization
Organization Name:ADVANCED ARTHRITIS CARE AT SHELBY
Other - Org Name:ADVANCE RHEUMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CHIEF INTEGRATION OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:FENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-715-5415
Mailing Address - Street 1:1130 22ND ST S
Mailing Address - Street 2:RIDGE PARK PLACE, SUITE 1000
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-2870
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1010 1ST ST N
Practice Address - Street 2:SUITE 250
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8608
Practice Address - Country:US
Practice Address - Phone:205-620-8676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST HEALTH CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-22
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP00759542OtherRAILROAD MEDICARE
AL107730Medicaid
ALP00759542OtherRAILROAD MEDICARE