Basic Information
| Provider Information | |||||||||
| NPI: | 1447406301 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRESTIGE FAMILY MEDICINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 830605 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352830605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057155943 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3400 HIGHWAY 78 E | ||||||||
| Address2: | MEDICAL ARTS TOWER; SUITE 110 | ||||||||
| City: | JASPER | ||||||||
| State: | AL | ||||||||
| PostalCode: | 355018907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053874401 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2008 | ||||||||
| LastUpdateDate: | 08/05/2015 | ||||||||
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| AuthorizedOfficialLastName: | NEAL | ||||||||
| AuthorizedOfficialFirstName: | VALETA | ||||||||
| AuthorizedOfficialMiddleName: | D. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2057155901 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BAPTIST HEALTH CENTERS, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.