1083697718 NPI number — RADIOLOGY ASSOCIATES OF DOTHAN PC

Table of content: (NPI 1083697718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083697718 NPI number — RADIOLOGY ASSOCIATES OF DOTHAN PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RADIOLOGY ASSOCIATES OF DOTHAN 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:
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:
1083697718
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2015 ALEXANDER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOTHAN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36301-3003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-671-1696
Provider Business Mailing Address Fax Number:
334-794-0721

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 FAIRVIEW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOTHAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36301-3008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-793-9511
Provider Business Practice Location Address Fax Number:
334-794-0721
Provider Enumeration Date:
11/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BECKETT
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
334-793-9511

Provider Taxonomy Codes

  • Taxonomy code: 2085N0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0204X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 274277202 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300040735A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000060028 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 113043200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com