Basic Information
| Provider Information | |||||||||
| NPI: | 1063171742 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IMC -GULF ORTHOPAEDICS LLC | ||||||||
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| Address1: | 1720 SPRING HILL AVE FL 3 | ||||||||
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| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366041410 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 831 HILLCREST RD STE C | ||||||||
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| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366954075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514352663 | ||||||||
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| ProviderEnumerationDate: | 12/10/2021 | ||||||||
| LastUpdateDate: | 12/10/2021 | ||||||||
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| AuthorizedOfficialLastName: | PALAZZO | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 2514351361 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.