1255439964 NPI number — BIRMINGHAM ENDODONTICS LLC

Table of content: ADAM EZRA GOODE M.D. (NPI 1568090322)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255439964 NPI number — BIRMINGHAM ENDODONTICS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BIRMINGHAM ENDODONTICS LLC
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:
1255439964
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:
202 INVERNESS CENTER DRIVE
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35242-7635
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-981-3301
Provider Business Mailing Address Fax Number:
205-981-3307

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 INVERNESS CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35242-7635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-981-3301
Provider Business Practice Location Address Fax Number:
205-981-3307
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AYCOCK
Authorized Official First Name:
KRISSIE
Authorized Official Middle Name:
BAKER
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
205-981-3301

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 51035548 . This is a "BCBS AL PROVIDER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51509043 . This is a "BCBS AL PROVIDER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 272124 . This is a "UCCI PROVIDER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 4289 . This is a "CISSELL STATE LICENSE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 5041 . This is a "CAPRARA STATE LICENSE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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