1932204856 NPI number — SPECIALIZED MEDICAL DEVICES INC

Table of content: (NPI 1932204856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932204856 NPI number — SPECIALIZED MEDICAL DEVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECIALIZED MEDICAL DEVICES INC
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:
1932204856
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3001 12TH AVE SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35805-4161
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-536-7676
Provider Business Mailing Address Fax Number:
256-536-7638

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2418 DANVILLE RD SW
Provider Second Line Business Practice Location Address:
STE D
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35603-4281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-353-2801
Provider Business Practice Location Address Fax Number:
256-536-7638
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KILLIAN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
256-536-7676

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , 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: 009941482 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com