Provider Demographics
NPI:1699904441
Name:ALABAMA MED & SURGICAL FOOT CENTER
Entity type:Organization
Organization Name:ALABAMA MED & SURGICAL FOOT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:WALDROP
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:205-655-1114
Mailing Address - Street 1:1960 GADSDEN HIGHWAY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235
Mailing Address - Country:US
Mailing Address - Phone:205-655-1114
Mailing Address - Fax:205-661-3585
Practice Address - Street 1:1960 GADSDEN HIGHWAY
Practice Address - Street 2:SUITE 120
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235
Practice Address - Country:US
Practice Address - Phone:205-655-1114
Practice Address - Fax:205-661-3585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL228213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU85192Medicare UPIN