1164618278 NPI number — DR. AMIR FALLAHIAN MD

Table of content: DR. AMIR FALLAHIAN MD (NPI 1164618278)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164618278 NPI number — DR. AMIR FALLAHIAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FALLAHIAN
Provider First Name:
AMIR
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1164618278
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2006 FRANKLIN ST SE STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35801-4537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-539-0457
Provider Business Mailing Address Fax Number:
256-539-5827

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2006 FRANKLIN ST SE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35801-4537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-539-0457
Provider Business Practice Location Address Fax Number:
256-539-5827
Provider Enumeration Date:
09/21/2007

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: 2085R0202X , with the licence number:  4301114640 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 0101264885 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 309023 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 45271 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 2351 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 37496 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 04-37669 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 30955 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 57476 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: MED-PHYS-LIC-64774 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 2018012676 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: A110683 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 12172836 . This is a "CAQH" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 225261 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 225752 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 225757 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 240027 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 242920 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 243171 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 225264 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 225750 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 225864 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 225872 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 242825 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 890-51518 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 242869 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 225663 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 225667 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 242813 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 225666 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 225869 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 107170900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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