Healthcare Provider Details

I. General information

NPI: 1508856352
Provider Name (Legal Business Name): EICH PLASTIC SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 01/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PILOT MEDICAL DRIVE SUITE 100
BIRMINGHAM AL
35235-3462
US

IV. Provider business mailing address

200 PILOT MEDICAL DRIVE SUITE 100
BIRMINGHAM AL
35235-3462
US

V. Phone/Fax

Practice location:
  • Phone: 205-856-6155
  • Fax: 205-856-9391
Mailing address:
  • Phone: 205-856-6155
  • Fax: 205-856-9391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number17710
License Number StateAL

VIII. Authorized Official

Name: MR. BRUCE SHELBY EICH II
Title or Position: PRESIDENT
Credential: MD
Phone: 205-856-6155