1427157239 NPI number — S.VISHWANATH MD PC

Table of content: (NPI 1427157239)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427157239 NPI number — S.VISHWANATH MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S.VISHWANATH 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:
1427157239
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1073 3RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORALA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36442-3231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-858-2050
Provider Business Mailing Address Fax Number:
334-858-2120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1073 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLORALA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36442-3231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-858-2050
Provider Business Practice Location Address Fax Number:
334-858-2120
Provider Enumeration Date:
09/21/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VISHWANATH
Authorized Official First Name:
SASIKUMAR
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
334-858-2050

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  19896 , 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: 51037033VIS . This is a "HUMANA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51037033VIS . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 000037033 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 214372179 . This is a "TRICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 251015400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110173224 . This is a "RAILROADMEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51037033VIS . This is a "AETNA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51037033VIS . This is a "BLUECROSS OF FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 51524095 . This is a "BLUECROSS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51037033VIS . This is a "BLUECROSS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".