1013110006 NPI number — DR. WILLIAM EDWARD LIEVENS M.D.

Table of content: EMMA LYNN FELD (NPI 1407561749)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013110006 NPI number — DR. WILLIAM EDWARD LIEVENS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIEVENS
Provider First Name:
WILLIAM
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1013110006
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2400 MIDFIELD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36111-1529
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-239-2838
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6001 E SHIRLEY LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36117-1935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-244-1618
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  29280 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084A0401X , with the licence number: 29280 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0600X , with the licence number: 29280 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084S0012X , with the licence number: 29280 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2800X , with the licence number: 29280 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 273100000X , with the licence number: 29280 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 29280 , 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: 29280 . This is a "ALABAMA STATE BOARD OF MEDICAL EXAMINERS, CONTROLLED SUBSTANCES REGISTRATION" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 3634532 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 57026 . This is a "BOARD CERTIFIED IN NEUROLOGY, AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY" identifier . This identifiers is of the category "OTHER".
  • Identifier: MD.29280 . This is a "ALABAMA MEDICAL LICENSURE COMMISSION" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 511-36880 . This is a "BLUE ADVANTAGE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 150070 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4448615 . This is a "CIGNA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 511-36880 . This is a "BLUE CROSS/BLUE SHIELD OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 12562126 . This is a "CAQH" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: XXXXX9748 . This is a "TRICARE / HUMANA MILITARY" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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