Provider Demographics
NPI:1952596975
Name:IMC- MOBILE OB/GYN CTR PC
Entity Type:Organization
Organization Name:IMC- MOBILE OB/GYN CTR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-433-1887
Mailing Address - Street 1:3 MOBILE INFIRMARY CIR
Mailing Address - Street 2:SUITE 201C
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-3520
Mailing Address - Country:US
Mailing Address - Phone:251-433-1887
Mailing Address - Fax:251-433-1929
Practice Address - Street 1:3 MOBILE INFIRMARY CIR
Practice Address - Street 2:SUITE 201C
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3520
Practice Address - Country:US
Practice Address - Phone:251-433-1887
Practice Address - Fax:251-433-1929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3443207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51003216OtherBLUE CROSS BLUE SHIELD
ALC038OtherMEDICARE LEGACY
ALC74843Medicare UPIN