Provider Demographics
NPI:1972558831
Name:BROOKWOOD INTERNAL MEDICINE, P.C.
Entity type:Organization
Organization Name:BROOKWOOD INTERNAL MEDICINE, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:CROW
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:205-871-7746
Mailing Address - Street 1:2017 CANYON ROAD
Mailing Address - Street 2:SUITE # 39
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1928
Mailing Address - Country:US
Mailing Address - Phone:205-871-7746
Mailing Address - Fax:205-871-9234
Practice Address - Street 1:2017 CANYON ROAD
Practice Address - Street 2:SUITE # 39
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216-1928
Practice Address - Country:US
Practice Address - Phone:205-871-7746
Practice Address - Fax:205-871-9234
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROOKWOOD INTERNAL MEDICINE, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-22
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALACSC7326OtherCHARLES B. CROW III, M.D.
AL1356338842OtherNPI CHARLES CROW
AL009941415Medicaid
AL009944205Medicaid
AL000095978Medicaid
AL000095980Medicaid
AL000095980Medicare PIN
AL009941415Medicaid
AL000095980Medicaid
AL000095978Medicaid
AL000095978Medicare PIN