1487779013 NPI number — ALMS CLINICAL ASSOCIATES

Table of content: (NPI 1487779013)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487779013 NPI number — ALMS CLINICAL ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALMS CLINICAL ASSOCIATES
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:
1487779013
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1514 HWY 17 BUS. N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SURFSIDE BEACH
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29575
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-238-6070
Provider Business Mailing Address Fax Number:
843-238-6071

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1514 HWY 17 BUS. N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SURFSIDE BEACH
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29575
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-238-6070
Provider Business Practice Location Address Fax Number:
843-238-6071
Provider Enumeration Date:
03/20/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LAMANNA
Authorized Official First Name:
ALBERT
Authorized Official Middle Name:
V
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
843-238-6070

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1791 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 1707 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X , with the licence number: MD2155 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CH1791 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".