1346490604 NPI number — FEAGIN & OWEN, M.D.., P.C.

Table of content: (NPI 1346490604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346490604 NPI number — FEAGIN & OWEN, M.D.., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FEAGIN & OWEN, M.D.., P.C.
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:
1346490604
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4300 W MAIN ST
Provider Second Line Business Mailing Address:
SUITE 43
Provider Business Mailing Address City Name:
DOTHAN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36305-1054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-793-7211
Provider Business Mailing Address Fax Number:
334-793-5425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4300 W MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 43
Provider Business Practice Location Address City Name:
DOTHAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36305-1054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-793-7211
Provider Business Practice Location Address Fax Number:
334-793-5425
Provider Enumeration Date:
09/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BYRD
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
C
Authorized Official Title or Position:
INSURANCE
Authorized Official Telephone Number:
334-793-7211

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  7921 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM2500X , with the licence number: 13944 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000011782 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000082133 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1427141282 . This is a "INDIVIDUAL NPI FOR DR. CHARLES FEAGIN" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1619062064 . This is a "INDIVIDUAL NPI FOR DR. WILLIAM I. OWEN" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 11782 . This is a "BCBS OF ALABAMA PROVIDER NUMBER -- CHARLES FEAGIN, M.D." identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 82133 . This is a "BCBS OF ALABAMA PROVIDER FOR DR. WILLIAM I. OWEN, JR" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 529001560 . This is a "ALABAMA MEDICAID PAYEE ID: 529001560" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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