MEDICARE: MIRANDA P FRITH PA-C

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	363AS0400X	Surgical Physician Assistant	PA.346	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	510I970130	OTHER	AL	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	051048148	OTHER	AL	BCBS OF AL
2	51048149	OTHER	AL	BCBS OF AL
3	051048150	OTHER	AL	BCBS OF AL
4	51048150	OTHER	AL	BCBS OF AL
5	51048148	OTHER	AL	BCBS OF AL
7	051048149	OTHER	AL	BCBS OF AL
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	510-00264	OTHER	AL	BCBS OF AL

General Provider Information

NPI Number	:	1538274238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA P FRITH PA-C

Provider Business Mailing Address
First Line	:	1940 STONEGATE DR STE 130
Second Line	:
City	:	VESTAVIA HLS
State	:	AL
Zip	:	35242-2541
Country	:	US
Telephone Number	:	205-977-9876
Fax Number	:	205-977-9976

Provider Business Practice Location Address
First Line	:	1940 STONEGATE DR STE 130
Second Line	:
City	:	VESTAVIA HLS
State	:	AL
Zip	:	35242
Country	:	US
Telephone Number	:	205-977-9876
Fax Number	:	205-977-9976

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	09/07/2018

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Directions to “ MIRANDA P FRITH PA-C” Practice Location

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