1356602205 NPI number — INMED CLINICAL SERVICES LLC

Table of content: TOBY PAULSON D.O. (NPI 1235264169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356602205 NPI number — INMED CLINICAL SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INMED CLINICAL SERVICES 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:
NORTH SHORE HEALTH CARE ASSOCIATES PRIMARY CARE
Provider Other Organization Name Type Code:
3
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:
1356602205
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5013
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36103-5013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-386-0343
Provider Business Mailing Address Fax Number:
334-386-0382

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
773 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAYTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30525-4257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-782-4233
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/06/2012

Additional Information

Authorized Official

Authorized Official Last Name:
LAWRENSON
Authorized Official First Name:
VICKI
Authorized Official Middle Name:
F
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
334-386-0343

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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