Organization
ENT BESSEMER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRETCHEN K GILLILAND (BILLING)
(205) 481-7780
Entity
Organization
Contact information
Practice address
985 9TH AVE SW, SUITE 308, BESSEMER, AL 35022-4500
(205) 481-7780
(205) 481-7740
Mailing address
985 9TH AVE SW, SUITE 308, BESSEMER, AL 35022-4500
(205) 481-7780
(205) 481-7740
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
12109
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1010135
UNITED HEALTHCARE
TX
01
—
420842449
TRICARE
SC
01
—
51045124
BLUE CROSS OF ALABAMA
AL
05
—
529900180
—
AL
Enumeration date
05/23/2008
Last updated
08/15/2011
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