1356434013 NPI number — HAHN LAU RPT

Table of content: HAHN LAU RPT (NPI 1356434013)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356434013 NPI number — HAHN LAU RPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAU
Provider First Name:
HAHN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPT
Provider Gender Code:
M

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:
1356434013
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7500 HUGH DANIEL DR
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35242-7148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-991-3300
Provider Business Mailing Address Fax Number:
205-991-3327

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 S ANNISTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYLACAUGA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35150-2904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-249-5500
Provider Business Practice Location Address Fax Number:
256-249-5506
Provider Enumeration Date:
10/02/2006

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: 225100000X , with the licence number:  PTH2015 , 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: 51532060 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009937653 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009934577 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".