=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538211024
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KELLEY SNOW MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2007
-----------------------------------------------------
Last Update Date | 07/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 985 9TH AVE SW STE. 507
-----------------------------------------------------
City | BESSEMER
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35022-4500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-481-7577
-----------------------------------------------------
Fax | 205-481-7580
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 985 9TH AVE SW STE. 507
-----------------------------------------------------
City | BESSEMER
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35022-7814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-481-7577
-----------------------------------------------------
Fax | 205-481-7580
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/SURGEON
-----------------------------------------------------
Name | DR. KELLEY M SNOW
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 205-481-7577
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 9110
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------