MEDICARE: BHC - MONTCLAIR INFECTIOUS DISEASES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053375196
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BHC - MONTCLAIR INFECTIOUS DISEASES

Provider Business Mailing Address
First Line	:	PO BOX 13128
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35202-3128
Country	:	US
Telephone Number	:	205-715-5904
Fax Number	:	205-715-5928

Provider Business Practice Location Address
First Line	:	840 MONTCLAIR RD
Second Line	:	SUITE 606
City	:	BIRMINGHAM
State	:	AL
Zip	:	35213-1920
Country	:	US
Telephone Number	:	205-592-5917
Fax Number	:	205-599-4911

Authorized Official
Title or Position	:	CHIEF INTEGRATION OFFICER
Name	:	G. SCOTT FENN
Credential	:
Telephone Number	:	205-715-5415

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	03/30/2009

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