Provider Demographics
NPI:1881132553
Name:THE BIRMINGHAM PAIN CENTER INC
Entity type:Organization
Organization Name:THE BIRMINGHAM PAIN CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-313-7246
Mailing Address - Street 1:4515 SOUTHLAKE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-3319
Mailing Address - Country:US
Mailing Address - Phone:205-313-7246
Mailing Address - Fax:205-939-1911
Practice Address - Street 1:4515 SOUTHLAKE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-3319
Practice Address - Country:US
Practice Address - Phone:205-313-7246
Practice Address - Fax:205-939-1911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16939291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory