Healthcare Provider Details

I. General information

NPI: 1346233640
Provider Name (Legal Business Name): BERNARD WILLIAM SIMIERITSCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15341 HIGHWAY 278
DOUBLE SPRINGS AL
35553-2407
US

IV. Provider business mailing address

15341 HIGHWAY 278
DOUBLE SPRINGS AL
35553-2407
US

V. Phone/Fax

Practice location:
  • Phone: 205-489-3322
  • Fax: 205-489-3325
Mailing address:
  • Phone: 205-489-3322
  • Fax: 205-489-3325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateAL

VIII. Authorized Official

Name: BERNARD WILLIAM SIMIERITSCH
Title or Position: OWNER
Credential: MD
Phone: 205-489-3322