1306088471 NPI number — CRNA SERVICES OF DGH

Table of content: RUTH S HUMPHREY LCSW (NPI 1023144581)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306088471 NPI number — CRNA SERVICES OF DGH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRNA SERVICES OF DGH
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:
1306088471
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2239
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DECATUR
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35609-2239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-341-2000
Provider Business Mailing Address Fax Number:
256-306-1691

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 7TH ST SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35601-3337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-341-2000
Provider Business Practice Location Address Fax Number:
256-306-1691
Provider Enumeration Date:
04/03/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CROWE
Authorized Official First Name:
DANNY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
256-341-2000

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  H5202 , 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: 110735 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: DP9284 . This is a "RR MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".