Basic Information
| Provider Information | |||||||||
| NPI: | 1538274238 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRITH | ||||||||
| FirstName: | MIRANDA | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1940 STONEGATE DR STE 130 | ||||||||
| Address2: | |||||||||
| City: | VESTAVIA HLS | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352422541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059779876 | ||||||||
| FaxNumber: | 2059779976 | ||||||||
| Practice Location | |||||||||
| Address1: | 1940 STONEGATE DR STE 130 | ||||||||
| Address2: | |||||||||
| City: | VESTAVIA HLS | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059779876 | ||||||||
| FaxNumber: | 2059779976 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2006 | ||||||||
| LastUpdateDate: | 09/07/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | PA.346 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 051048148 | 01 | AL | BCBS OF AL | OTHER | 51048149 | 01 | AL | BCBS OF AL | OTHER | 051048150 | 01 | AL | BCBS OF AL | OTHER | 51048150 | 01 | AL | BCBS OF AL | OTHER | 51048148 | 01 | AL | BCBS OF AL | OTHER | 510I970130 | 01 | AL | MEDICARE | OTHER | 051048149 | 01 | AL | BCBS OF AL | OTHER | 107776 | 05 | AL | MEDICAID | 510-00264 | 01 | AL | BCBS OF AL | OTHER |