1295818573 NPI number — CHIVERS R WOODRUFF MD PC

Table of content: (NPI 1295818573)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295818573 NPI number — CHIVERS R WOODRUFF MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHIVERS R WOODRUFF MD PC
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:
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:
1295818573
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/26/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 660986
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VESTAVIA HILLS
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35266-0986
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-532-1888
Provider Business Mailing Address Fax Number:
256-532-3941

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1220 17TH ST S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35205-4747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-532-1888
Provider Business Practice Location Address Fax Number:
256-532-3941
Provider Enumeration Date:
10/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WOODRUFF
Authorized Official First Name:
CHIVERS
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER/MD
Authorized Official Telephone Number:
256-532-1888

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00077538 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".




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