Provider Demographics
NPI:1023319563
Name:ROBERT J SCIACCA MD PC
Entity type:Organization
Organization Name:ROBERT J SCIACCA MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATARA
Authorized Official - Middle Name:D
Authorized Official - Last Name:POLLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-985-7393
Mailing Address - Street 1:4515 SOUTHLAKE PKWY
Mailing Address - Street 2:STE 300
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-3317
Mailing Address - Country:US
Mailing Address - Phone:205-985-7393
Mailing Address - Fax:205-987-1332
Practice Address - Street 1:4515 SOUTHLAKE PKWY
Practice Address - Street 2:STE 300
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-3317
Practice Address - Country:US
Practice Address - Phone:205-985-7393
Practice Address - Fax:205-987-1332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8954207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51104671OtherBCBS
AL040004918OtherMCRRR
AL118134Medicaid
AL167432400OtherOWCP
AL040004918OtherMCRRR
AL118134Medicaid