MEDICARE: BROOKWOOD CENTER DEVELOPMENT CORPORATION

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	261QR0200X	Radiology Clinic/Center	11009	AL

General Provider Information

NPI Number	:	1568496628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKWOOD CENTER DEVELOPMENT CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 740799
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-0799
Country	:	US
Telephone Number	:	205-877-2453
Fax Number	:	205-871-0534

Provider Business Practice Location Address
First Line	:	513 BROOKWOOD BLVD STE 100
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209-6878
Country	:	US
Telephone Number	:	205-877-1000
Fax Number	:

Authorized Official
Title or Position	:	VP OF GOVT PROGRAMS, TENET
Name	:	MR. CRAIG C. ARMIN
Credential	:
Telephone Number	:	310-775-8043

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	04/28/2016

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