| Dark Side Medical, Llc | |
|
5130 Cyrus Cir Birmingham AL 35242-4630 | |
| (205) 981-0414 | |
| (888) 330-6501 |
| Full Name | Dark Side Medical, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 5130 Cyrus Cir, Birmingham, Alabama |
| Authorized Official Name and Position | Victor Estrada Mendoza (OWNER AND TREATING PHYSICIAN) |
| Authorized Official Contact | 2569976182 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dark Side Medical, Llc 5130 Cyrus Cir Birmingham AL 35242-4630 Ph: (205) 981-0414 | Dark Side Medical, Llc 5130 Cyrus Cir Birmingham AL 35242-4630 Ph: (205) 981-0414 |
| NPI Number | 1609153030 |
|---|---|
| Provider Enumeration Date | 11/14/2011 |
| Last Update Date | 11/14/2011 |
| Medicare PECOS PAC ID | 4284809773 |
|---|---|
| Medicare Enrollment ID | O20111212000705 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609153030 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | 25607 (Alabama) | Primary |
| Provider Name | Victor E Mendoza |
|---|---|
| Provider Type | Practitioner - Interventional Pain Management |
| Provider Identifiers | NPI Number: 1003831454 PECOS PAC ID: 6103819172 Enrollment ID: I20040406000413 |
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