Basic Information
| Provider Information | |||||||||
| NPI: | 1306967427 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRIMARY CARE CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 703 VOLKER HALL | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352940001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059343795 | ||||||||
| FaxNumber: | 2059752499 | ||||||||
| Practice Location | |||||||||
| Address1: | 1616 6TH AVE S | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352331788 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059399096 | ||||||||
| FaxNumber: | 2055582181 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 08/13/2007 | ||||||||
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| AuthorizedOfficialLastName: | ASHWORTH | ||||||||
| AuthorizedOfficialFirstName: | CAROLYN | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIVISION DIRECTOR, GENERAL PEDIATRI | ||||||||
| AuthorizedOfficialTelephone: | 2059399585 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.