1174587067 NPI number — MERCY MEDICAL, A CORPORATION

Table of content: DR. JOHN WILLIAM KNISPEL MD (NPI 1508349556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174587067 NPI number — MERCY MEDICAL, A CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY MEDICAL, A CORPORATION
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:
1174587067
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1090
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAPHNE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36526-1090
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
374 GREENO RD S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRHOPE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36532-1916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-621-4431
Provider Business Practice Location Address Fax Number:
251-621-4896
Provider Enumeration Date:
04/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BORRONI
Authorized Official First Name:
NECIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO/EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
251-459-6454

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  11712 , 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: MER7034A , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 017034 . This is a "MEDICARE OSCAR NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51535174 . This is a "BC BS OF AL PROVER NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 9245 . This is a "HEALTHSPRING PROVIDER NUM" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51041160 . This is a "BCBS OF AL PROVIDER NUM" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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