Patrick Ifediba MD LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

19014 Issued in AL

Legal business name

PATRICK IFEDIBA MD LLC

Practice address

1300 Bessemer Rd
Birmingham, AL 35208-4326

Phone

(205) 929-0565

Fax

(205) 929-0564

NPI assigned

Oct 30, 2007

Organization subpart

No

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

Authorized official

Name

Patrick Emeka Ifediba, M.D.

Title

Director

Phone

(205) 929-0565

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1193702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279497600000",
    "number": "1902085582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 59472",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352599472",
            "telephone_number": "205-929-0565",
            "fax_number": "205-929-0564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 BESSEMER RD",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352084326",
            "telephone_number": "205-929-0565",
            "fax_number": "205-929-0564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATRICK IFEDIBA MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-30",
        "last_updated": "2010-07-19",
        "status": "A",
        "authorized_official_last_name": "IFEDIBA",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "EMEKA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "205-929-0565",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": "19014",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "51000499",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "051554814",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pathway Healthcare Alabama LLC
• Pathway Healthcare Alabama LLC
• Pathway Ministries
• Madhava Sarma Patibanda, M.D.
• Patricia A Patrician, RN
• Alyssa Patrick, PHARM D
• Kelly Patrick, R.D.
• Madison Michelle Patrick
• Patriot Healthcare of Alabama, LLC
• Patriot Healthcare of Alabama, LLC

• Internal Medicine Physician in Birmingham, AL
• Providers in Birmingham, AL by specialty
• Internal Medicine Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2010; 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.