Provider Demographics
NPI:1396756730
Name:BBSMD PC
Entity type:Organization
Organization Name:BBSMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:B
Authorized Official - Last Name:SELLERS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:256-234-4443
Mailing Address - Street 1:125 ALISON DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-4469
Mailing Address - Country:US
Mailing Address - Phone:256-234-4443
Mailing Address - Fax:256-234-3686
Practice Address - Street 1:125 ALISON DR
Practice Address - Street 2:SUITE 5
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-4469
Practice Address - Country:US
Practice Address - Phone:256-234-4443
Practice Address - Fax:256-234-3686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9546208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51002295OtherBCBS PROVIDER NUMBER
AL51504902OtherBCBS PROVIDER NUMBER
AL51556901Medicare ID - Type UnspecifiedPROVIDER NUMBER
AL51504902OtherBCBS PROVIDER NUMBER
AL51002295OtherBCBS PROVIDER NUMBER
AL51504902Medicare ID - Type UnspecifiedPROVIDER NUMBER