1467434373 NPI number — GHAYAS ALI HABACH M.D., M.P.H.

Table of content: GHAYAS ALI HABACH M.D., M.P.H. (NPI 1467434373)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467434373 NPI number — GHAYAS ALI HABACH M.D., M.P.H.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HABACH
Provider First Name:
GHAYAS
Provider Middle Name:
ALI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D., M.P.H.
Provider Gender Code:
M

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:
1467434373
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2038
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYLACAUGA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35150-5038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-249-0028
Provider Business Mailing Address Fax Number:
256-249-0019

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
291 JAMES PAYTON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYLACAUGA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35150-8047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-249-0028
Provider Business Practice Location Address Fax Number:
256-249-0019
Provider Enumeration Date:
11/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  17714 , 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: 51536235 . This is a "BCBS - CBURG" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 529927850 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51504549 . This is a "BC/BS - SYLACAUGA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 51517000 . This is a "BC/BS - GOODWATER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 51524305 . This is a "BC/BS - CITIZENS HOSPITAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 543928002 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009939531 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 529908510 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009974915 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009974925 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51523146 . This is a "BC/BS - LANDMARK DIALYSIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 51536048 . This is a "BCBS TALL CLINIC" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 540003928 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000077420 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009940116 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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