Provider Demographics
NPI:1245088236
Name:ICH ER SERVICES OF ALABAMA LLC
Entity type:Organization
Organization Name:ICH ER SERVICES OF ALABAMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:EADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-740-0895
Mailing Address - Street 1:13000 DEERFIELD PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-6118
Mailing Address - Country:US
Mailing Address - Phone:770-740-0895
Mailing Address - Fax:
Practice Address - Street 1:2015 S ALABAMA AVE
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36460
Practice Address - Country:US
Practice Address - Phone:251-575-3111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-07
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty