1346309663 NPI number — ALABAMA HEALTHCARE DEVELOPMENT LLC

Table of content: (NPI 1346309663)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346309663 NPI number — ALABAMA HEALTHCARE DEVELOPMENT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALABAMA HEALTHCARE DEVELOPMENT LLC
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:
1346309663
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2467 JOHN HAWKINS PKWY
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
HOOVER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35244-3538
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-987-6801
Provider Business Mailing Address Fax Number:
205-987-6810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2467 JOHN HAWKINS PKWY
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
HOOVER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35244-3538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-987-6801
Provider Business Practice Location Address Fax Number:
205-987-6810
Provider Enumeration Date:
12/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MICHEL
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OWNER MANAGER
Authorized Official Telephone Number:
205-987-6801

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  MD.27738 , 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: MD.27738 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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