1114308335 NPI number — ROSEMARIE CAILLIER, DPM, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114308335 NPI number — ROSEMARIE CAILLIER, DPM, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROSEMARIE CAILLIER, DPM, 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:
1114308335
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3546 BROOK HIGHLAND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUSCALOOSA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35406-2952
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-409-0175
Provider Business Mailing Address Fax Number:
205-764-5937

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2002 MCFARLAND BLVD E
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
TUSCALOOSA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35404-5856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-409-0175
Provider Business Practice Location Address Fax Number:
205-764-5800
Provider Enumeration Date:
06/12/2015

Additional Information

Authorized Official

Authorized Official Last Name:
CAILLIER
Authorized Official First Name:
ROSEMARIE
Authorized Official Middle Name:
JACK
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
585-203-7486

Provider Taxonomy Codes

  • Taxonomy code: 213EP1101X , with the licence number:  313 , 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: 187474 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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