MEDICARE: BROOKWOOD OPHTHALMOLOGY IMAGING AND ANCILLARY SERVICES

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	207V00000X	Obstetrics & Gynecology Physician
2	207W00000X	Ophthalmology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00301433	OTHER	AL	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51533857	OTHER	AL	BCBS MARION
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	51533202	OTHER	AL	BCBS AL BROOKWOOD
5	4648847	OTHER	AL	AETNA
6	A96597	OTHER	AL	VIVA
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	213985282	OTHER	AL	TRICARE STANDARD HUMANA

General Provider Information

NPI Number	:	1386849669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKWOOD OPHTHALMOLOGY IMAGING AND ANCILLARY SERVICES

Provider Business Mailing Address
First Line	:	1 CHASE CORPORATE DR STE 439
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35244-1026
Country	:	US
Telephone Number	:	205-313-6300
Fax Number	:	253-645-4859

Provider Business Practice Location Address
First Line	:	1 CHASE CORPORATE DR STE 439
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35244-1026
Country	:	US
Telephone Number	:	205-313-6300
Fax Number	:	253-465-4859

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. JANIE NORFLEET WHITE
Credential	:
Telephone Number	:	205-383-9498

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	05/11/2023

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Directions to “BROOKWOOD OPHTHALMOLOGY IMAGING AND ANCILLARY SERVICES ” Practice Location

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