| Magic City Wellness Center | |
|
3220 5th Ave S Ste 100 Birmingham AL 35222-2309 | |
| (205) 877-8677 | |
| (205) 877-8675 |
| Full Name | Magic City Wellness Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 3220 5th Ave S Ste 100, Birmingham, Alabama |
| Authorized Official Name and Position | Will Rainer (DIRECTOR) |
| Authorized Official Contact | 2058778677 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Magic City Wellness Center 3220 5th Ave S Ste 100 Birmingham AL 35222-2309 Ph: (205) 877-8677 | Magic City Wellness Center 3220 5th Ave S Ste 100 Birmingham AL 35222-2309 Ph: (205) 877-8677 |
| NPI Number | 1336507953 |
|---|---|
| Provider Enumeration Date | 02/10/2016 |
| Last Update Date | 09/28/2020 |
| Medicare PECOS PAC ID | 6608129747 |
|---|---|
| Medicare Enrollment ID | O20181019000678 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336507953 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 075108 (Alabama) | Primary |
| Provider Name | Scott R Weisberg |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912998147 PECOS PAC ID: 5799732186 Enrollment ID: I20050407000533 |
| Provider Name | Rodney O Tucker |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730101932 PECOS PAC ID: 6608808977 Enrollment ID: I20050907000990 |
| Provider Name | Joshua S Hicks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871986810 PECOS PAC ID: 0941529036 Enrollment ID: I20150512002790 |
| Provider Name | Shana B Wheeler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275050387 PECOS PAC ID: 5193065464 Enrollment ID: I20190322002047 |
| Provider Name | Terry Brock |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851991954 PECOS PAC ID: 4183012826 Enrollment ID: I20211028001854 |
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