1013245257 NPI number — KACI M BYRD CHEESEMAN P.A.

Table of content: KACI M BYRD CHEESEMAN P.A. (NPI 1013245257)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013245257 NPI number — KACI M BYRD CHEESEMAN P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BYRD CHEESEMAN
Provider First Name:
KACI
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BYRD
Provider Other First Name:
KACI
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1013245257
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
251 N BAYOU ST
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:
36603-5827
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-690-8158
Provider Business Mailing Address Fax Number:
251-544-2188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
950 W COY SMITH HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT VERNON
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36560-3201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-829-9884
Provider Business Practice Location Address Fax Number:
251-829-9507
Provider Enumeration Date:
11/30/2009

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: 363A00000X , with the licence number:  PA681 , 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: 1063439065 . This is a "GROUP NPI PAYEE NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 630000013 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 011846 . This is a "MAIN GROUP MEDICARE PAYEE NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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