Healthcare Provider Details

I. General information

NPI: 1588219711
Provider Name (Legal Business Name): ALABAMA DIGESTIVE HEALTH ENDOSCOPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 01/07/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 BROOKWOOD MEDICAL CTR DR
BIRMINGHAM AL
35209-6898
US

IV. Provider business mailing address

2018 BROOKWOOD MEDICAL CTR DR
BIRMINGHAM AL
35209-6898
US

V. Phone/Fax

Practice location:
  • Phone: 205-877-1187
  • Fax:
Mailing address:
  • Phone: 205-877-1187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: TARA SHEA
Title or Position: ADMINISTRATOR
Credential:
Phone: 205-877-1192