1962747543 NPI number — FOCUS-MD COM-1006-AL, LLC

Table of content: (NPI 1962747543)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962747543 NPI number — FOCUS-MD COM-1006-AL, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOCUS-MD COM-1006-AL, 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:
FOCUS MD
Provider Other Organization Name Type Code:
3
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:
1962747543
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8159
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36689-0159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-414-5810
Provider Business Mailing Address Fax Number:
251-414-5809

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28080 US HIGHWAY 98
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
DAPHNE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36526-7005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-517-9025
Provider Business Practice Location Address Fax Number:
251-517-9026
Provider Enumeration Date:
12/07/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COLE
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING COORDINATOR
Authorized Official Telephone Number:
251-300-2060

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RA0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0006X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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