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General NPI Number Information
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NPI Number | 1629274022
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Entity Type | Organization
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Legal Business Name | JERRY MCLANE INTERNAL MEDICINE LLC
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Dates
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Enumeration Date | 06/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1088 9TH AVE SW SUITE 106
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City | BESSEMER
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State | AL
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Zip | 35022-4530
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Country | US
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Telephone | 205-424-5664
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Fax | 205-424-1564
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Provider Business Mailing Address
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Address Line | PO BOX 430
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City | BESSEMER
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State | AL
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Zip | 35021-0430
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Country | US
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Telephone | 205-424-5664
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Fax | 205-424-1564
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MARY KELLY SULLIVAN
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Credential | R.N.
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Telephone | 205-424-5664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 8903
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License Number State | AL
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