1033153358 NPI number — JONATHAN L LEVINE MD, PC

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 1033153358 NPI number — JONATHAN L LEVINE MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JONATHAN L LEVINE MD, PC
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:
6
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:
1033153358
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
833 SAINT VINCENTS DR
Provider Second Line Business Mailing Address:
POB #3 SUITE 402
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35205-1606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-631-8116
Provider Business Mailing Address Fax Number:
205-631-8114

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
931 SHARIT AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
GARDENDALE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-631-8116
Provider Business Practice Location Address Fax Number:
205-631-8114
Provider Enumeration Date:
06/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
O'NEAL
Authorized Official First Name:
MARSHA
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
205-631-8116

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  00020375 , 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)





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