Provider Demographics
NPI:1841352929
Name:BIRMINGHAM PAIN MANAGEMENT & REHABILITATION CENTERS, PC
Entity type:Organization
Organization Name:BIRMINGHAM PAIN MANAGEMENT & REHABILITATION CENTERS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:KELSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-783-7705
Mailing Address - Street 1:801 PRINCETON AVENUE SW
Mailing Address - Street 2:POB I SUITE 201
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-1310
Mailing Address - Country:US
Mailing Address - Phone:205-783-7705
Mailing Address - Fax:205-783-7706
Practice Address - Street 1:801 PRINCETON AVE SW
Practice Address - Street 2:POB I SUITE 201
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1310
Practice Address - Country:US
Practice Address - Phone:205-783-7705
Practice Address - Fax:205-783-7706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16871208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1932016895OtherINDIVIDUAL NPI
AL529914300Medicaid
AL1932016895OtherINDIVIDUAL NPI
ALE51202Medicare UPIN