Healthcare Provider Details

I. General information

NPI: 1972991321
Provider Name (Legal Business Name): BRADLEY HILL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2015
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 10TH AVE S STE 200
BIRMINGHAM AL
35205-1248
US

IV. Provider business mailing address

3204 NE 17TH ST
ANKENY IA
50021-4170
US

V. Phone/Fax

Practice location:
  • Phone: 205-259-3991
  • Fax: 205-683-2468
Mailing address:
  • Phone: 515-290-6880
  • Fax: 308-646-0168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number099669
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: