1346314366 NPI number — CHARLES T NEVELS MD PC

Table of content: (NPI 1346314366)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346314366 NPI number — CHARLES T NEVELS MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLES T NEVELS 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:
1346314366
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 40204
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:
35404-0204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-556-8391
Provider Business Mailing Address Fax Number:
205-553-3323

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4406 OXFORD GATE DR
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:
35405-4767
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-556-8391
Provider Business Practice Location Address Fax Number:
205-553-3323
Provider Enumeration Date:
11/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NEVELS
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
205-556-8391

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  00025226 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0805X , with the licence number: 00025226 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208D00000X , with the licence number: 00025226 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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