1366626285 NPI number — SOUTHEAST ALABAMA MEDICAL CENTER

Table of content: (NPI 1366626285)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366626285 NPI number — SOUTHEAST ALABAMA MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHEAST ALABAMA MEDICAL CENTER
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:
SAMC
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:
1366626285
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1108 ROSS CLARK CIRCLE
Provider Second Line Business Mailing Address:
ATTN: PHYSICAL THERAPY DEPT
Provider Business Mailing Address City Name:
DOTHAN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-712-3726
Provider Business Mailing Address Fax Number:
334-712-3553

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1108 ROSS CLARK CIR
Provider Second Line Business Practice Location Address:
ATTN: PHYSICAL THERAPY DEPT
Provider Business Practice Location Address City Name:
DOTHAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36301-3022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-712-3726
Provider Business Practice Location Address Fax Number:
334-712-3553
Provider Enumeration Date:
12/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LAND
Authorized Official First Name:
CECILIA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF REHAB
Authorized Official Telephone Number:
334-712-3726

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  PTH3336 , 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)





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