1295940260 NPI number — GREATER ALABAMA FAMILY FOOT CARE INC

Table of content: (NPI 1295940260)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295940260 NPI number — GREATER ALABAMA FAMILY FOOT CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREATER ALABAMA FAMILY FOOT CARE INC
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:
1295940260
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1026
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANETT
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36863-1026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-642-3668
Provider Business Mailing Address Fax Number:
334-642-3669

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26 VETERANS MEMORIAL PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANETT
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36863-2840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-642-3668
Provider Business Practice Location Address Fax Number:
334-642-3669
Provider Enumeration Date:
05/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GREEN
Authorized Official First Name:
RONA
Authorized Official Middle Name:
RENELL
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
334-642-3668

Provider Taxonomy Codes

  • Taxonomy code: 261QP1100X , with the licence number:  193 , 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: 193 . This is a "AL STATE LIC. NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51510661 . This is a "AL BCBS NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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