Provider Demographics
NPI:1740314194
Name:PRIMARY CARE MEDICINE HDL CLINIC LLC
Entity type:Organization
Organization Name:PRIMARY CARE MEDICINE HDL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARUNJOTI
Authorized Official - Middle Name:A
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-788-7988
Mailing Address - Street 1:PO BOX 660612
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35266
Mailing Address - Country:US
Mailing Address - Phone:205-788-7988
Mailing Address - Fax:205-780-0883
Practice Address - Street 1:801 PRINCETON AVE SW
Practice Address - Street 2:PROFESSIONAL OFFICE BUILDING ONE SUITE 210
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211
Practice Address - Country:US
Practice Address - Phone:205-788-7988
Practice Address - Fax:205-790-0883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALDN8162OtherRAILROAD MEDICARE
ALDN8162OtherRAILROAD MEDICARE