NPIMap

Organization Active NPI

Patriot Healthcare of Alabama, LLC

  • Geriatric Medicine (Family Medicine) Physician
  • Birmingham, AL
National Provider Identifier
1225507692
Registry record updated Nov 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
Legal business name
PATRIOT HEALTHCARE OF ALABAMA, LLC
Doing business as
PHC of AL Lakeshore
Practice address
One West Lakeshore Drive
Suite 250
Birmingham, AL 35209
Phone
(205) 420-8629
NPI assigned
Nov 15, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
David A. Culver
Title
Administrator
Phone
(904) 825-4368

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207QG0300X Primary

Addresses

Primary practice location

One West Lakeshore Drive
Suite 250
Birmingham, AL 35209

Mailing address

100 Arricola Avenue
St. Augustine, FL 32080
Phone (904) 825-4368

Other names 1

  • PHC of AL Lakeshore Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Patriot Healthcare of Alabama LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1542240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542240000000",
    "number": "1225507692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 ARRICOLA AVENUE",
            "city": "ST. AUGUSTINE",
            "state": "FL",
            "postal_code": "32080",
            "telephone_number": "904-825-4368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ONE WEST LAKESHORE DRIVE",
            "address_2": "SUITE 250",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "35209",
            "telephone_number": "205-420-8629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATRIOT HEALTHCARE OF ALABAMA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-15",
        "last_updated": "2018-11-15",
        "status": "A",
        "authorized_official_last_name": "CULVER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "904-825-4368"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHC of AL Lakeshore",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Birmingham, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.