1336169606 NPI number — EAST ALABAMA MENTAL HEALTH-MENTAL RETARDATION BOARD INCORPOR

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 1336169606 NPI number — EAST ALABAMA MENTAL HEALTH-MENTAL RETARDATION BOARD INCORPOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST ALABAMA MENTAL HEALTH-MENTAL RETARDATION BOARD INCORPOR
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:
EAST ALABAMA MENTAL HEALTH CENTER
Provider Other Organization Name Type Code:
3
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:
1336169606
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2506 LAMBERT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OPELIKA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36801-7237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-742-2733
Provider Business Mailing Address Fax Number:
334-742-2833

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2506 LAMBERT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OPELIKA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36801-7237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-742-2733
Provider Business Practice Location Address Fax Number:
334-742-2833
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COTNEY
Authorized Official First Name:
ANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST
Authorized Official Telephone Number:
334-742-2700

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 114528 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2134256 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100002807 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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