1114974276 NPI number — DR. CARL ARTHUR HUMPHRIES DMD

Table of content: (NPI 1053608000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114974276 NPI number — DR. CARL ARTHUR HUMPHRIES DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUMPHRIES
Provider First Name:
CARL
Provider Middle Name:
ARTHUR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
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:
1114974276
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 586
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARAB
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35016-0586
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-586-1330
Provider Business Mailing Address Fax Number:
256-586-1329

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 12TH AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARAB
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35016-5403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-586-1330
Provider Business Practice Location Address Fax Number:
256-586-1329
Provider Enumeration Date:
05/27/2006

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: 1223G0001X , with the licence number:  3859 , 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: 009998930 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 510-93552 . This is a "BC/BS OF AL PROVIDER NO." identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 4348602 . This is a "AETNA PROVIDER NO." identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 0121721 . This is a "BC/BS OF TN PROVIDER NO." identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: AL3859 . This is a "MUTUAL OF OMAHA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 7102000000AL . This is a "BC/BS OF MI PROVIDER NO" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 848340 . This is a "UNITED CONCORDIA PROVIDER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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