Provider Demographics
NPI:1245546993
Name:PEDIATRIC NEPHROLOGY OF ALABAMA, P.C.
Entity type:Organization
Organization Name:PEDIATRIC NEPHROLOGY OF ALABAMA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAX
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-562-0025
Mailing Address - Street 1:1425 RICHARD ARRINGTON JR BLVD S
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-3898
Mailing Address - Country:US
Mailing Address - Phone:205-558-3200
Mailing Address - Fax:205-558-2055
Practice Address - Street 1:1425 RICHARD ARRINGTON JR BLVD S
Practice Address - Street 2:SUITE 206
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-3898
Practice Address - Country:US
Practice Address - Phone:205-558-3200
Practice Address - Fax:205-558-2055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL122842080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric NephrologyGroup - Single Specialty