1912068354 NPI number — GARY ALAN CALHOUN FAMILY PRACTICE LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912068354 NPI number — GARY ALAN CALHOUN FAMILY PRACTICE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GARY ALAN CALHOUN FAMILY PRACTICE LLC
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:
1912068354
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 668
Provider Second Line Business Mailing Address:
P O BOX 668
Provider Business Mailing Address City Name:
ALBERTVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35950-0012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-505-6826
Provider Business Mailing Address Fax Number:
256-582-1100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
227 BRIDLE RIDGE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBERTVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35950-9285
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-505-6826
Provider Business Practice Location Address Fax Number:
256-582-1100
Provider Enumeration Date:
12/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CALHOUN
Authorized Official First Name:
GARY
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
256-505-6826

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  15304 , 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: I415 . This is a "MEDICARE GROUP" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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