NPIMap

Organization Active NPI

Mibella Gynecology, LLC

Doing business as Mibella Wellness Center

  • Gynecology Physician
  • Birmingham, AL
National Provider Identifier
1720393606
Registry record updated Sep 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
License
27416 Issued in AL
Legal business name
MIBELLA GYNECOLOGY, LLC
Doing business as
Mibella Wellness Center
Practice address
2807 Greystone Commercial Blvd
Unit 38
Birmingham, AL 35242-9601
Phone
(205) 995-1009
Fax
(205) 995-1049
NPI assigned
Aug 16, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2021

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

Authorized official

Name
Mia T Cowan, M.D.NPI 1831127083
Title
President
Phone
(205) 995-1009

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207VG0400X 27416 AL Primary

Addresses

Primary practice location

2807 Greystone Commercial Blvd
Unit 38
Birmingham, AL 35242-9601

Mailing address

2807 Greystone Commercial Blvd
Unit 38
Birmingham, AL 35242-9601
Phone (205) 995-1009

Other identifiers 2

IdentifierTypeStateIssuer
27416OtherALLICENSE
1831127083MedicaidAL

Other names 1

  • MIBELLA WELLNESS CENTER Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101123000028 AL Part B Supplier - Clinic/Group Practice 0547456196 Receives reassigned benefits from 4 practitioners
Practice locations: Birmingham, AL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D2014300Mibella Gynecology LLC2807 Greystone Commercial Blvd, Unit 38, Birmingham, AL 35242Provider-performed microscopyOct 4, 2026

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1281916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632873600000",
    "number": "1720393606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2807 GREYSTONE COMMERCIAL BLVD",
            "address_2": "UNIT 38",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352429601",
            "telephone_number": "205-995-1009",
            "fax_number": "205-995-1049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2807 GREYSTONE COMMERCIAL BLVD",
            "address_2": "UNIT 38",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352429601",
            "telephone_number": "205-995-1009",
            "fax_number": "205-995-1049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIBELLA GYNECOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-16",
        "last_updated": "2021-09-29",
        "certification_date": "2021-09-29",
        "status": "A",
        "authorized_official_last_name": "COWAN",
        "authorized_official_first_name": "MIA",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "205-995-1009",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "AL",
            "license": "27416",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "27416",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1831127083",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MIBELLA WELLNESS CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MIBELLA WELLNESS CENTER",
            "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 Sep 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.