NPIMap

Organization Active NPI

Imc Mobile Bay OBGYN Center PC

  • Obstetrics & Gynecology Physician
  • Mobile, AL
National Provider Identifier
1730124504
Registry record updated Feb 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
IMC MOBILE BAY OBGYN CENTER PC
Practice address
3 Mobile Infirmary Cir
Ste 201
Mobile, AL 36607-3514
Phone
(251) 435-7900
Fax
(251) 435-6261
NPI assigned
Jun 17, 2006
Last updated
Feb 21, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2013

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

Authorized official

Name
R Barre Sanders
Title
Director Officer
Phone
(251) 435-2400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X Primary

Addresses

Primary practice location

3 Mobile Infirmary Cir
Ste 201
Mobile, AL 36607-3514

Mailing address

3 Mobile Infirmary Cir
Ste 201
Mobile, AL 36607-3514
Phone (251) 435-7900

Other identifiers 2

IdentifierTypeStateIssuer
528902340MedicaidAL
0552570001OtherALCIGNA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040907001085 AL Part B Supplier - Clinic/Group Practice 6709852155 Receives reassigned benefits from 8 practitioners
Practice locations: Mobile, AL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

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": "1150502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361404800000",
    "number": "1730124504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 MOBILE INFIRMARY CIR",
            "address_2": "STE 201",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366073514",
            "telephone_number": "251-435-7900",
            "fax_number": "251-435-6261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 MOBILE INFIRMARY CIR",
            "address_2": "STE 201",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366073514",
            "telephone_number": "251-435-7900",
            "fax_number": "251-435-6261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMC MOBILE BAY OBGYN CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-17",
        "last_updated": "2013-02-21",
        "status": "A",
        "authorized_official_last_name": "SANDERS",
        "authorized_official_first_name": "R",
        "authorized_official_middle_name": "BARRE",
        "authorized_official_title_or_position": "DIRECTOR OFFICER",
        "authorized_official_telephone_number": "251-435-2400"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "528902340",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "0552570001",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mobile, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.