Healthcare Provider Details

I. General information

NPI: 1720177603
Provider Name (Legal Business Name): BIRMINGHAM VA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 19TH ST S
BIRMINGHAM AL
35233-1927
US

IV. Provider business mailing address

700 19TH ST S
BIRMINGHAM AL
35233-1927
US

V. Phone/Fax

Practice location:
  • Phone: 205-558-4756
  • Fax: 205-975-7487
Mailing address:
  • Phone: 205-558-4756
  • Fax: 205-975-7487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number1-073531
License Number StateAL

VIII. Authorized Official

Name: MRS. KIMBERLY DIONNE KELLY
Title or Position: HIV COORDINATOR
Credential: CRNP
Phone: 205-558-4756