Provider Demographics
NPI:1013244946
Name:ALT MD, PC
Entity Type:Organization
Organization Name:ALT MD, PC
Other - Org Name:HOOVER ALT MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:CAMPBELL
Authorized Official - Last Name:KORCZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-936-2203
Mailing Address - Street 1:3421 S SHADES CREST RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-3550
Mailing Address - Country:US
Mailing Address - Phone:205-936-2203
Mailing Address - Fax:
Practice Address - Street 1:3421 S SHADES CREST RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-3550
Practice Address - Country:US
Practice Address - Phone:205-936-2203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty