Healthcare Provider Details

I. General information

NPI: 1043756513
Provider Name (Legal Business Name): BESSEMER FAMILY FOOT CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 4TH AVE N
BESSEMER AL
35020-4838
US

IV. Provider business mailing address

1721 4TH AVE N
BESSEMER AL
35020-4838
US

V. Phone/Fax

Practice location:
  • Phone: 205-424-2540
  • Fax:
Mailing address:
  • Phone: 205-424-2540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number00174
License Number StateAL

VIII. Authorized Official

Name: DR. CYNTHIA HOBDY
Title or Position: PODIATRIST
Credential: D.P.M.
Phone: 205-424-2540