Provider Demographics
NPI:1184771636
Name:CHILDRENS MEDICAL GROUP P C
Entity type:Organization
Organization Name:CHILDRENS MEDICAL GROUP P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LASKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-515-0538
Mailing Address - Street 1:2316 7TH AVE S STE 100
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-3215
Mailing Address - Country:US
Mailing Address - Phone:205-251-4141
Mailing Address - Fax:205-251-2004
Practice Address - Street 1:2316 7TH AVE S
Practice Address - Street 2:SUITE 100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-3200
Practice Address - Country:US
Practice Address - Phone:205-251-4141
Practice Address - Fax:205-251-2004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC76742Medicare UPIN
ALC76772Medicare UPIN
ALG46198Medicare UPIN
ALC76604Medicare UPIN