1669412292 NPI number — MICHAEL F DEVENNY MD

Table of content: MICHAEL F DEVENNY MD (NPI 1669412292)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669412292 NPI number — MICHAEL F DEVENNY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEVENNY
Provider First Name:
MICHAEL
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1669412292
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
208 MCFARLAND CIR N
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
TUSCALOOSA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35406-1800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-345-7000
Provider Business Mailing Address Fax Number:
205-343-0910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 MCFARLAND CIR N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUSCALOOSA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35406-1800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-345-7000
Provider Business Practice Location Address Fax Number:
205-343-0910
Provider Enumeration Date:
06/08/2006

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: 2085R0202X , with the licence number:  16759 , 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: 009989490 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009989530 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009989560 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009989730 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009989510 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000036419 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009989450 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009989520 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009989540 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009989550 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009989440 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009993560 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009989500 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009989460 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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