1427194273 NPI number — GUM CREEK ENTERPRISES INC

Table of content: (NPI 1427194273)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427194273 NPI number — GUM CREEK ENTERPRISES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GUM CREEK ENTERPRISES INC
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:
COMFACARE HOME HEALTH SUPPLY
Provider Other Organization Name Type Code:
3
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:
1427194273
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1250
Provider Second Line Business Mailing Address:
929 4TH ST NW
Provider Business Mailing Address City Name:
RED BAY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35582-1250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-356-9111
Provider Business Mailing Address Fax Number:
256-356-9111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
929 4TH ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RED BAY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35582-1250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-356-9111
Provider Business Practice Location Address Fax Number:
256-356-9111
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MASON
Authorized Official First Name:
MELISA
Authorized Official Middle Name:
C
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
256-356-9111

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , 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: 00440339 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51031062 . This is a "BCBS AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009606550 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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