1063477644 NPI number — MOBILE HEART SPECIALISTS PC

Table of content: (NPI 1063477644)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063477644 NPI number — MOBILE HEART SPECIALISTS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOBILE HEART SPECIALISTS 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:
THE HEART GROUP, P.C.
Provider Other Organization Name Type Code:
4
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:
1063477644
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6701 AIRPORT BLVD
Provider Second Line Business Mailing Address:
SUITE A-107
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36608-6705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-433-4700
Provider Business Mailing Address Fax Number:
251-435-8615

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6701 AIRPORT BLVD
Provider Second Line Business Practice Location Address:
SUITE A-107
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36608-6705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-433-4700
Provider Business Practice Location Address Fax Number:
251-435-8615
Provider Enumeration Date:
04/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROGERS
Authorized Official First Name:
BELINDA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
251-435-8572

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00119745 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000029329 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09014562 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1558349860 . This is a "NPI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: C2022 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 000008468 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009902515 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000033302 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1114905429 . This is a "NPI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1467433524 . This is a "NPI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: G363 . This is a "MEDICARE GRP MOBILE INF" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: G364 . This is a "MEDICARE GRP PROV" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 00115660 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00126607 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1982685640 . This is a "NPI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 529601560 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00121124 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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