1477627024 NPI number — CITY OF PRATTVILLE

Table of content: (NPI 1477627024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477627024 NPI number — CITY OF PRATTVILLE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF PRATTVILLE
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:
1477627024
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 MAIN ST W
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
PRATTVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36067-3034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-358-3670
Provider Business Mailing Address Fax Number:
334-358-0113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 MAIN ST W
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
PRATTVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36067-3034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-358-3670
Provider Business Practice Location Address Fax Number:
334-358-0113
Provider Enumeration Date:
11/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TUCKER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
334-358-3238

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  348 , 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: 0510-50157 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 000050157 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590000128 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".