Healthcare Provider Details

I. General information

NPI: 1568804805
Provider Name (Legal Business Name): KMBRIGGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SHADOW WOOD PARK
BIRMINGHAM AL
35244-3447
US

IV. Provider business mailing address

104 W GREEN
VESTAVIA AL
35243-1872
US

V. Phone/Fax

Practice location:
  • Phone: 205-403-0556
  • Fax:
Mailing address:
  • Phone: 205-403-0556
  • Fax: 205-972-8084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. MARTIN A BRIGGS
Title or Position: MANAGER
Credential:
Phone: 205-403-0556