MEDICARE: COMMUNITY PRESBYTERIAN CENTER

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	251V00000X	Voluntary or Charitable Agency

General Provider Information

NPI Number	:	1578796496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY PRESBYTERIAN CENTER

Provider Business Mailing Address
First Line	:	BOX 11434
Second Line	:	BRUNO-SMITHFIELD COMMUNITY HEALTH CENTER
City	:	BIRMINGHAM
State	:	AL
Zip	:	35204-1434
Country	:	US
Telephone Number	:	205-368-3733
Fax Number	:

Provider Business Practice Location Address
First Line	:	421 REVEREND ABRAHAM WOODS JR BLVD
Second Line	:	BRUNO-SMITHFIELD COMMUNTY HEALTH CENTER
City	:	BIRMINGHAM
State	:	AL
Zip	:	35204-3715
Country	:	US
Telephone Number	:	205-368-3733
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL SERVICES DIRECTOR/PI
Name	:	DR. THOMAS R ELLISON
Credential	:	PHD
Telephone Number	:	205-368-3733

Provider Enumeration Date	:	08/26/2009
Last Update Date	:	08/26/2009

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