1194811497 NPI number — NORTH ALABAMA OBSTETRICS AND GYNECOLOGY

Table of content: (NPI 1194811497)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194811497 NPI number — NORTH ALABAMA OBSTETRICS AND GYNECOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH ALABAMA OBSTETRICS AND GYNECOLOGY
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:
MADISON OBSTETRICS AND GYNECOLOGY
Provider Other Organization Name Type Code:
5
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:
1194811497
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3809 SULLIVAN ST
Provider Second Line Business Mailing Address:
SUITE 6-A
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35758-2372
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-461-4104
Provider Business Mailing Address Fax Number:
256-461-4840

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3809 SULLIVAN ST
Provider Second Line Business Practice Location Address:
SUITE 6-A
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35758-2372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-461-4104
Provider Business Practice Location Address Fax Number:
256-461-4840
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOPEZ
Authorized Official First Name:
RAYMOND
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
256-461-4104

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  18239 , 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: 51097396 . This is a "BLUE CROSS&BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com