Provider Demographics
NPI:1881972073
Name:SOUTHERN CARE INTERNAL MEDICINE PC
Entity type:Organization
Organization Name:SOUTHERN CARE INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ILLESCAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-547-2323
Mailing Address - Street 1:10 MEADOWVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-7700
Mailing Address - Country:US
Mailing Address - Phone:205-547-2323
Mailing Address - Fax:205-995-0955
Practice Address - Street 1:10 MEADOWVIEW DR
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35242-7700
Practice Address - Country:US
Practice Address - Phone:205-547-2323
Practice Address - Fax:205-995-0955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-22
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty