Basic Information
| Provider Information | |||||||||
| NPI: | 1285656843 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PAUL SCALICI FAMILY MEDICINE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2204 LAKESHORE DRIVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2058748300 | ||||||||
| FaxNumber: | 2058748333 | ||||||||
| Practice Location | |||||||||
| Address1: | 1020 26TH STREET SOUTH | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053971275 | ||||||||
| FaxNumber: | 2053971279 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SCALICI | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2058748300 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | AL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 51518603 | 01 | AL | BCBS | OTHER |