1023054244 NPI number — MR. JOE NORMAN WILKES II CRNA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023054244 NPI number — MR. JOE NORMAN WILKES II CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILKES
Provider First Name:
JOE
Provider Middle Name:
NORMAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
II
Provider Credential Text:
CRNA
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:
1023054244
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
226 BRANDY DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINFIELD
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35594
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-487-4843
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NORTHWEST MEDICAL CENTER
Provider Second Line Business Practice Location Address:
1530 US HIGHWAY 43
Provider Business Practice Location Address City Name:
WINFIELD
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35594
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-487-7000
Provider Business Practice Location Address Fax Number:
205-487-7645
Provider Enumeration Date:
06/22/2006

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: 367500000X , with the licence number:  1-094772 , 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: 515-22617 . This is a "BCBS AL PIN" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-22751 . This is a "BCBS AL -LAMAR SURG CTR" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com