Provider Demographics
NPI:1427325687
Name:ST JUDE THADDEUS INTERNAL MEDICINE
Entity type:Organization
Organization Name:ST JUDE THADDEUS INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:M
Authorized Official - Last Name:VELUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-956-8767
Mailing Address - Street 1:5431 BEACON DR
Mailing Address - Street 2:
Mailing Address - City:IRONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35210-2862
Mailing Address - Country:US
Mailing Address - Phone:205-956-8767
Mailing Address - Fax:205-956-8704
Practice Address - Street 1:5431 BEACON DR
Practice Address - Street 2:
Practice Address - City:IRONDALE
Practice Address - State:AL
Practice Address - Zip Code:35210-2862
Practice Address - Country:US
Practice Address - Phone:205-956-8767
Practice Address - Fax:205-956-8704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD 9246146M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, IntermediateGroup - Single Specialty