MEDICARE: DR. SAMUEL R GOLDSTEIN M.D.

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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	11500	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	200039736	OTHER	AL	RAILROAD MEDICARE
4	051522083	OTHER	AL	MEDICARE LEGACY #
6	000097724	OTHER	AL	MEDICARE LEGACY#

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	09-10143	OTHER	AL	UNITED HEALTHCARE
2	168252100	OTHER	AL	FEDERAL WORK COMP
5	51114077	OTHER	AL	BLUE CROSS AND BLUE SHIELD
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427020122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL R GOLDSTEIN M.D.

Provider Business Mailing Address
First Line	:	805 SAINT VINCENTS DR
Second Line	:	SUITE 100
City	:	BIRMINGHAM
State	:	AL
Zip	:	35205-1636
Country	:	US
Telephone Number	:	205-939-3699
Fax Number	:	205-581-7155

Provider Business Practice Location Address
First Line	:	805 SAINT VINCENTS DR
Second Line	:	SUITE 100
City	:	BIRMINGHAM
State	:	AL
Zip	:	35205-1636
Country	:	US
Telephone Number	:	205-939-3699
Fax Number	:	205-581-7155

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	06/20/2014

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Directions to “ DR. SAMUEL R GOLDSTEIN M.D.” Practice Location

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