Healthcare Provider Details

I. General information

NPI: 1043734619
Provider Name (Legal Business Name): AMERICA INSTITUTE OF REPRODUCTIVE MEDICINE - ALABAMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 INDEPENDENCE PLZ STE 810
BIRMINGHAM AL
35209-2647
US

IV. Provider business mailing address

1 INDEPENDENCE PLZ STE 810
BIRMINGHAM AL
35209-2647
US

V. Phone/Fax

Practice location:
  • Phone: 205-441-1302
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH B BOLEN IV
Title or Position: ADMINISTRATOR
Credential:
Phone: 205-515-4217