Provider Demographics
NPI:1427188119
Name:ALEX CITY INTERNAL MEDICINE & NEPHROLOGY
Entity type:Organization
Organization Name:ALEX CITY INTERNAL MEDICINE & NEPHROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIMTCHO
Authorized Official - Middle Name:V
Authorized Official - Last Name:POPOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-409-1500
Mailing Address - Street 1:3368 HIGHWAY 280
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-3393
Mailing Address - Country:US
Mailing Address - Phone:256-409-1500
Mailing Address - Fax:256-409-1144
Practice Address - Street 1:3368 HIGHWAY 280
Practice Address - Street 2:SUITE 220
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-3393
Practice Address - Country:US
Practice Address - Phone:256-409-1500
Practice Address - Fax:256-409-1144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2014-05-05
Deactivation Date:2007-10-29
Deactivation Code:
Reactivation Date:2014-05-05
Provider Licenses
StateLicense IDTaxonomies
AL20515174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009931175Medicaid
AL51516344OtherBCBS
ALG40197Medicare UPIN
AL051516344Medicare ID - Type UnspecifiedPROVIDER NUMBER