Provider Demographics
NPI:1588705883
Name:BIRMINGHAM PODIATRY PC
Entity type:Organization
Organization Name:BIRMINGHAM PODIATRY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:205-324-8511
Mailing Address - Street 1:1985 ALABAMA HWY 157
Mailing Address - Street 2:SUITE A
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058
Mailing Address - Country:US
Mailing Address - Phone:256-739-1912
Mailing Address - Fax:205-314-8551
Practice Address - Street 1:1985 ALABAMA HWY 157
Practice Address - Street 2:SUITE A
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058
Practice Address - Country:US
Practice Address - Phone:256-739-1912
Practice Address - Fax:205-314-8551
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIRMINGHAM PODIATRY PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-09
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51070700OtherBLUE CROSS
AL528902460Medicaid
AL528902460Medicaid
AL51070700OtherBLUE CROSS
AL0538190001Medicare NSC