1063471589 NPI number — GEORGE E NGANDO MD

Table of content: GEORGE E NGANDO MD (NPI 1063471589)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063471589 NPI number — GEORGE E NGANDO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NGANDO
Provider First Name:
GEORGE
Provider Middle Name:
E
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:
1063471589
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10583
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35202-0583
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-435-2646
Provider Business Mailing Address Fax Number:
251-435-6478

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 MOBILE INFIRMARY CIR
Provider Second Line Business Practice Location Address:
MOBILE EMERGENCY GROUP
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36607-3513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-435-2646
Provider Business Practice Location Address Fax Number:
251-435-6478
Provider Enumeration Date:
03/22/2006

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: 207P00000X , with the licence number:  MD.26585 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: MD.26585 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: MD.26585 , 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: 510-49856 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009936017 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 515-36030 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009936016 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009938358 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009935237 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009938357 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 515-36029 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 0099636018 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051531467 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1063471589 . This is a "TRICARE SOUTH" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: 515-32812 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-33204 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-33205 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 100675600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".