1003235094 NPI number — COMPLEX SOLUTIONS LLC

Table of content: (NPI 1003235094)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003235094 NPI number — COMPLEX SOLUTIONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPLEX SOLUTIONS 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:
ETOWAH PAIN ASSOCIATES
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:
1003235094
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1941
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GADSDEN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35902-1941
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3015 STEELE STATION RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAINBOW CITY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35906-8722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-456-5811
Provider Business Practice Location Address Fax Number:
256-485-0753
Provider Enumeration Date:
04/08/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHEHI
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
LYLE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
256-456-5811

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP3300X , with the licence number: PM.163 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 511-79613 . This is a "BLUE CROSS AND BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".