Healthcare Provider Details

I. General information

NPI: 1235251810
Provider Name (Legal Business Name): PHYSICIANS MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CARRAWAY BLVD
BIRMINGHAM AL
35234-1913
US

IV. Provider business mailing address

PO BOX 830469 MSC 511
BIRMINGHAM AL
35283-0469
US

V. Phone/Fax

Practice location:
  • Phone: 205-502-6000
  • Fax: 205-502-5720
Mailing address:
  • Phone: 205-979-8552
  • Fax: 205-979-1248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberH3703
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS A GALLAGHER
Title or Position: PRESIDENT
Credential:
Phone: 615-665-1223