1588673206 NPI number — PERFORMANCE GROUP BIRMINGHAM, LLC

Table of content: (NPI 1588673206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588673206 NPI number — PERFORMANCE GROUP BIRMINGHAM, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERFORMANCE GROUP BIRMINGHAM, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588673206
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 OFFICE PARK CIR
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35223-2511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-871-7242
Provider Business Mailing Address Fax Number:
205-871-7240

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2017 CANYON RD
Provider Second Line Business Practice Location Address:
SUITE 21
Provider Business Practice Location Address City Name:
VESTAVIA HILLS
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35216-1900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-822-8320
Provider Business Practice Location Address Fax Number:
205-822-8323
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HESTER
Authorized Official First Name:
LORA
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OFFICE ADMINISTRATOR
Authorized Official Telephone Number:
205-871-7294

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com