1013028828 NPI number — AG PODIATRIC SPECIALIST AND ASSOCIATES

Table of content: (NPI 1013028828)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013028828 NPI number — AG PODIATRIC SPECIALIST AND ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AG PODIATRIC SPECIALIST AND ASSOCIATES
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:
1013028828
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1529 BESSEMER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35208-4016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-925-5272
Provider Business Mailing Address Fax Number:
205-925-5278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1529 BESSEMER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35208-4016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-925-5272
Provider Business Practice Location Address Fax Number:
205-925-5278
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AGEE
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
205-925-5272

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X , with the licence number:  103 , 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: 069765001 . This is a "DEMERC PROVIDER NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: P00105372 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 000031102 . This is a "EUFAULA PROVIDER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1013028828 . This is a "ORGANIZATIONAL NPI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 2710019 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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