Provider Demographics
NPI:1740470251
Name:BROOKWOOD PRIMARY CARE HOOVER, L.L.C.
Entity type:Organization
Organization Name:BROOKWOOD PRIMARY CARE HOOVER, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL CFO, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:O
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-265-5009
Mailing Address - Street 1:4902 VALLEYDALE RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-4613
Mailing Address - Country:US
Mailing Address - Phone:205-980-8099
Mailing Address - Fax:205-980-2606
Practice Address - Street 1:2547 JOHN HAWKINS PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-3554
Practice Address - Country:US
Practice Address - Phone:205-988-8311
Practice Address - Fax:205-988-3590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL26468207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510G700013Medicare PIN