1013989995 NPI number — DR. BARRY S CALLAHAN MD

Table of content: DR. BARRY S CALLAHAN MD (NPI 1013989995)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013989995 NPI number — DR. BARRY S CALLAHAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CALLAHAN
Provider First Name:
BARRY
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013989995
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2447
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUSCALOOSA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35403-2447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-345-0192
Provider Business Mailing Address Fax Number:
205-464-4507

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 PAUL W BRYANT DR E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUSCALOOSA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35401-2055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-345-0192
Provider Business Practice Location Address Fax Number:
205-464-4507
Provider Enumeration Date:
02/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  33914 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0106X , with the licence number: ME102420 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0106X , with the licence number: 33914 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0106X , with the licence number: 19772 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 206729 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4011644 . This is a "BCBS OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 61852 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 207049 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 208156 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 206727 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3853851 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 511-99733 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 206198 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 511-99731 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 180360 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4010644 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 511-71913 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 511-99732 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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