Healthcare Provider Details

I. General information

NPI: 1053302497
Provider Name (Legal Business Name): EASTERN MEDICAL SPECIALISTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 MEDICAL PARK DR E SUITE 457
BIRMINGHAM AL
35235-3400
US

IV. Provider business mailing address

48 MEDICAL PARK DR E SUITE 457
BIRMINGHAM AL
35235-3400
US

V. Phone/Fax

Practice location:
  • Phone: 205-838-3800
  • Fax: 205-838-3206
Mailing address:
  • Phone: 205-838-3800
  • Fax: 205-838-3206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. MICHELLE P RONK
Title or Position: PRACTICE MANAGER
Credential:
Phone: 205-838-3800