Provider Demographics
NPI:1932389715
Name:ALEXANDER CITY DERMATOLOGY
Entity Type:Organization
Organization Name:ALEXANDER CITY DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MACKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-409-2159
Mailing Address - Street 1:125 ALISON DR
Mailing Address - Street 2:SUITE 8
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-4469
Mailing Address - Country:US
Mailing Address - Phone:256-409-2159
Mailing Address - Fax:334-501-7031
Practice Address - Street 1:125 ALISON DR
Practice Address - Street 2:SUITE 8
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-4469
Practice Address - Country:US
Practice Address - Phone:256-409-2159
Practice Address - Fax:334-501-7031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14427207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0731200138OtherCIGNA
AL000038661Medicaid
AL0005960521OtherAETNA
AL51038661OtherBLUE CROSS
AL529703210Medicaid
AL529703210Medicaid
AL0005960521OtherAETNA
AL=========003OtherTRICARE
AL000038661Medicaid
AL=========001OtherTRICARE
AL=========006OtherTRICARE
ALK146Medicare PIN
AL=========005OtherTRICARE
AL=========001OtherTRICARE