Healthcare Provider Details

I. General information

NPI: 1356092167
Provider Name (Legal Business Name): BIRMINGHAM INTERNAL MEDICINE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2834 MOODY PKWY
MOODY AL
35004-3101
US

IV. Provider business mailing address

74 PLAZA DR
PELL CITY AL
35125-9370
US

V. Phone/Fax

Practice location:
  • Phone: 205-640-2808
  • Fax:
Mailing address:
  • Phone: 205-814-9284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: ROBIN CAMPBELL
Title or Position: DIRECTOR, ENTERPRISE REVENUE CYCLE
Credential:
Phone: 205-995-9909