1073601340 NPI number — MUHAMMAD AMJAD MD

Table of content: MUHAMMAD AMJAD MD (NPI 1073601340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073601340 NPI number — MUHAMMAD AMJAD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMJAD
Provider First Name:
MUHAMMAD
Provider Middle Name:
Provider Name Prefix Text:
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:
1073601340
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1508 S BROAD ST STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSBORO
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35768-2668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-259-3600
Provider Business Mailing Address Fax Number:
256-259-3601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1508 S BROAD ST STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSBORO
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35768-2668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-259-3600
Provider Business Practice Location Address Fax Number:
256-259-3601
Provider Enumeration Date:
10/11/2006

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: 208000000X , with the licence number:  24797 , 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: 009907805 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1073601340 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1376966416 . This is a "GROUP NPI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1021377281 . This is a "MEDICARE PTAN" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 155726 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51597531 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 156513 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".