1306939467 NPI number — MUHAMMAD EJAZ ATA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306939467 NPI number — MUHAMMAD EJAZ ATA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MUHAMMAD EJAZ ATA
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:
6
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:
1306939467
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 246
Provider Second Line Business Mailing Address:
6110 COUNTY ROAD 88
Provider Business Mailing Address City Name:
PISGAH
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35765-0246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-451-1250
Provider Business Mailing Address Fax Number:
256-451-1270

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6110 COUNTY ROAD 88
Provider Second Line Business Practice Location Address:
PISGAH MEDICAL CLINIC
Provider Business Practice Location Address City Name:
PISGAH
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-451-1250
Provider Business Practice Location Address Fax Number:
256-451-1270
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ATA
Authorized Official First Name:
MUHAMMAD
Authorized Official Middle Name:
EJAZ
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
256-451-1250

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CM0511 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 011432 . This is a "BLUE CROSS OF ALABAMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 541003864 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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