1255439964 NPI number — BIRMINGHAM ENDODONTICS LLC

Table of content: (NPI 1255439964)

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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