Healthcare Provider Details

I. General information

NPI: 1588688246
Provider Name (Legal Business Name): ASSOCIATED MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 09/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 2ND ST NE SUITE B
ALABASTER AL
35007
US

IV. Provider business mailing address

PO BOX 130070
BIRMINGHAM AL
35213-0070
US

V. Phone/Fax

Practice location:
  • Phone: 205-664-4377
  • Fax: 205-664-3694
Mailing address:
  • Phone: 205-871-0050
  • Fax: 205-871-0050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number18247
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number18247
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number18247
License Number StateAL

VIII. Authorized Official

Name: DR. LELAND N ALLEN III
Title or Position: PRESIDENT
Credential: M.D.
Phone: 205-871-0050