Provider Demographics
NPI:1740391002
Name:BREASTCARE CENTER OF BIRMINGHAM
Entity type:Organization
Organization Name:BREASTCARE CENTER OF BIRMINGHAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MGR/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-314-2452
Mailing Address - Street 1:2018 BROOKWOOD MEDICAL CTR DR
Mailing Address - Street 2:POB SUITE 305
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6898
Mailing Address - Country:US
Mailing Address - Phone:205-877-2987
Mailing Address - Fax:205-877-2983
Practice Address - Street 1:2006 BROOKWOOD MEDICAL CTR DR STE 410
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6823
Practice Address - Country:US
Practice Address - Phone:205-877-2987
Practice Address - Fax:205-877-2983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00022902174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty