1336553213 NPI number — MALLORY RIGGS

Table of content: MALLORY RIGGS (NPI 1336553213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336553213 NPI number — MALLORY RIGGS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIGGS
Provider First Name:
MALLORY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SIGLE
Provider Other First Name:
MALLORY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336553213
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1908 FLINT RD SE
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:
35601-6031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-340-9708
Provider Business Mailing Address Fax Number:
256-340-9624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVERGREEN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36401-2847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-578-6863
Provider Business Practice Location Address Fax Number:
251-578-6865
Provider Enumeration Date:
06/18/2014

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: 261QP2000X , with the licence number:  PTH6914 , 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: 529917620 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1003819608 . This is a "GROUP NPI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".