1053306068 NPI number — DANIEL M ANDRESS MD

Table of content: (NPI 1548069420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053306068 NPI number — DANIEL M ANDRESS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDRESS
Provider First Name:
DANIEL
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1053306068
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11407
Provider Second Line Business Mailing Address:
DRAWER 0314
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35246-0314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-751-4664
Provider Business Mailing Address Fax Number:
405-751-3183

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 SIVLEY RD SW
Provider Second Line Business Practice Location Address:
EM DEPT
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35801-4421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-265-9905
Provider Business Practice Location Address Fax Number:
256-265-9910
Provider Enumeration Date:
09/15/2005

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: 207P00000X , with the licence number:  00019229 , 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: 009936101 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051030175 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 000030175 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3075041 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 5836024 . This is a "AETNA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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