1275890840 NPI number — SCOT C. CALLAHAN, M.D. , P.C.

Table of content: (NPI 1275890840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275890840 NPI number — SCOT C. CALLAHAN, M.D. , P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCOT C. CALLAHAN, M.D. , P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CALLAHAN ENT & FACIAL PLASTICS
Provider Other Organization Name Type Code:
5
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:
1275890840
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 E BRUNSON ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
ENTERPRISE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36330-2526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-393-6673
Provider Business Mailing Address Fax Number:
334-347-9599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 E BRUNSON ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
ENTERPRISE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36330-2526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-393-6673
Provider Business Practice Location Address Fax Number:
334-347-9599
Provider Enumeration Date:
04/19/2012

Additional Information

Authorized Official

Authorized Official Last Name:
CALLAHAN
Authorized Official First Name:
SCOT
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
334-393-6673

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  18006 , 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: 000077626 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1023096427 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com