1083619332 NPI number — WILEY HUGH JUSTICE M.D.

Table of content: MAYA ANDRICKA SAINT-VIL (NPI 1538950829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083619332 NPI number — WILEY HUGH JUSTICE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JUSTICE
Provider First Name:
WILEY
Provider Middle Name:
HUGH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1083619332
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 40277
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36688-0277
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-445-9378
Provider Business Mailing Address Fax Number:
251-445-9377

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5721 USA NORTH DR
Provider Second Line Business Practice Location Address:
HAHN 1119
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36688-0002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-445-9378
Provider Business Practice Location Address Fax Number:
251-445-9377
Provider Enumeration Date:
06/14/2005

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: 207Y00000X , with the licence number:  00007930 , 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: 000034502 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51511917 . This is a "BLUE CROSS AL PROVIDER #" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51034502 . This is a "BLUE CROSS PROVIDER #" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: C71226 . This is a "HEALTHSPRING PROVIDER #" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 4006616 . This is a "AETNA PROVIDER #" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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