1275538498 NPI number — DAVID T COZART MD, FACS

Table of content: DAVID T COZART MD, FACS (NPI 1275538498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275538498 NPI number — DAVID T COZART MD, FACS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COZART
Provider First Name:
DAVID
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD, FACS
Provider Gender Code:
M

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:
1275538498
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1120 S JACKSON HWY STE 203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHEFFIELD
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35660-5770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-314-6947
Provider Business Mailing Address Fax Number:
256-314-6902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1120 S JACKSON HWY STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHEFFIELD
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35660-5770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-314-6947
Provider Business Practice Location Address Fax Number:
256-314-6902
Provider Enumeration Date:
06/15/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  26645 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 020025948 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4674488 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3031352 . This is a "BLUE CROSS OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3091276 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".