Healthcare Provider Details

I. General information

NPI: 1629089701
Provider Name (Legal Business Name): ALABAMA HEAD AND NECK CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 MEMORIAL DR SUITE 108
BESSEMER AL
35022-6032
US

IV. Provider business mailing address

PO BOX 1445
BESSEMER AL
35021-1445
US

V. Phone/Fax

Practice location:
  • Phone: 205-424-1450
  • Fax: 205-424-6077
Mailing address:
  • Phone: 205-424-1450
  • Fax: 205-424-6077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number572-A
License Number StateAL

VIII. Authorized Official

Name: DR. JORGE ALBERTO CACERES
Title or Position: PRESIDENT / PHYSICIAN
Credential: M.D.
Phone: 205-424-1450