Provider Demographics
NPI:1316912934
Name:OBSTETRICS AND GYNECOLOGY OF WEST ALABAMA PC
Entity type:Organization
Organization Name:OBSTETRICS AND GYNECOLOGY OF WEST ALABAMA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-339-3039
Mailing Address - Street 1:2750 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35476-3360
Mailing Address - Country:US
Mailing Address - Phone:205-339-3039
Mailing Address - Fax:205-339-9908
Practice Address - Street 1:2750 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35476-3360
Practice Address - Country:US
Practice Address - Phone:205-339-3039
Practice Address - Fax:205-339-9908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17027174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL00028095Medicaid
ALG01167Medicare UPIN
AL000028095Medicare ID - Type Unspecified