1346212016 NPI number — SHOALS PATHOLOGY ASSOCIATES INC

Table of content: (NPI 1346212016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346212016 NPI number — SHOALS PATHOLOGY ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHOALS PATHOLOGY ASSOCIATES 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:
1346212016
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7111 FAIRWAY DR
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
PALM BEACH GARDENS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33418-4207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-712-6200
Provider Business Mailing Address Fax Number:
561-712-7349

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 BEVERLY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUSCLE SHOALS
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35661-3255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-383-1160
Provider Business Practice Location Address Fax Number:
256-381-9755
Provider Enumeration Date:
02/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KRAMER
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
M
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
610-550-3000

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  01D0641610 , 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: 531800201 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7001359 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05854236 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0027663 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 51054185 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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