1356490627 NPI number — AZALEA PHYSICIANS FOR WOMEN, P.C.

Table of content: (NPI 1356490627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356490627 NPI number — AZALEA PHYSICIANS FOR WOMEN, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AZALEA PHYSICIANS FOR WOMEN, 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:
1356490627
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2126 W ROY PARKER RD
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
OZARK
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36360-8566
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-445-1025
Provider Business Mailing Address Fax Number:
334-445-1026

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2126 W ROY PARKER RD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
OZARK
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36360-8566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-445-1025
Provider Business Practice Location Address Fax Number:
334-445-1026
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DULANEY
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
334-445-1025

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  00023709 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207V00000X , with the licence number: 00026094 , 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: 529919790 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com