Provider Demographics
NPI:1538211024
Name:KELLEY SNOW MD PC
Entity type:Organization
Organization Name:KELLEY SNOW MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-481-7577
Mailing Address - Street 1:985 9TH AVE SW
Mailing Address - Street 2:STE. 507
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-7814
Mailing Address - Country:US
Mailing Address - Phone:205-481-7577
Mailing Address - Fax:205-481-7580
Practice Address - Street 1:985 9TH AVE SW
Practice Address - Street 2:STE. 507
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-4500
Practice Address - Country:US
Practice Address - Phone:205-481-7577
Practice Address - Fax:205-481-7580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9110174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
006433OtherMEDICARE RAILROAD GROUP
AL000018743Medicaid
200041630OtherMEDICARE RAILROAD IND.
ALC75509Medicare UPIN
AL5321050001Medicare NSC
AL000018743Medicaid
AL051556679Medicare PIN