1225197197 NPI number — WEST ALABAMA NEPHROLOGY, PC

Table of content: (NPI 1225197197)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225197197 NPI number — WEST ALABAMA NEPHROLOGY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST ALABAMA NEPHROLOGY, 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:
1225197197
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4400 WATERMELON RD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
NORTHPORT
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35473-5204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-345-6302
Provider Business Mailing Address Fax Number:
205-247-4300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4400 WATERMELON RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
NORTHPORT
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35473-5204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-345-6302
Provider Business Practice Location Address Fax Number:
205-247-4300
Provider Enumeration Date:
12/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ALILONU
Authorized Official First Name:
GEOFFREY
Authorized Official Middle Name:
N
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
205-345-6302

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  9748 , 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: 103380 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 28996 . This is a "AL LICENSE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51591962 . This is a "BCBS NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 000037267 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51037267 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 529603880 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9748 . This is a "AL LICENSE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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