Provider Demographics
NPI:1184789588
Name:BIRMINGHAM EAR, NOSE & THROAT GROUP, PC
Entity type:Organization
Organization Name:BIRMINGHAM EAR, NOSE & THROAT GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOWRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-933-2952
Mailing Address - Street 1:2700 10TH AVE S STE 502
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1250
Mailing Address - Country:US
Mailing Address - Phone:205-933-2952
Mailing Address - Fax:205-933-5893
Practice Address - Street 1:2700 10TH AVE S STE 502
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1250
Practice Address - Country:US
Practice Address - Phone:205-933-2952
Practice Address - Fax:205-933-5893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00010997207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000032702Medicaid
ALG60661Medicare UPIN
AL000017040Medicare ID - Type UnspecifiedLEV H. BRAGG, M.D.
AL000032702Medicare ID - Type UnspecifiedH. BALTER LEJEUNE, M.D.
AL000032702Medicaid