1366464216 NPI number — JULIAN EDWARD MCINTYRE MD

Table of content: MARIA HOLCOMB (NPI 1023803897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366464216 NPI number — JULIAN EDWARD MCINTYRE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCINTYRE
Provider First Name:
JULIAN
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1366464216
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 BROWN SPRINGS RD
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:
36117-7005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-747-4159
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2055 E SOUTH BLVD STE 806
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36116-2007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-747-8920
Provider Business Practice Location Address Fax Number:
334-747-8930
Provider Enumeration Date:
07/23/2006

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: 207V00000X , with the licence number:  00015065 , 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: 201920 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2103641 . This is a "CIGNA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 511-94296 . This is a "BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 511-94297 . This is a "BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: F10006 . This is a "VIVA HEALTH" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: P01873138 . This is a "RR MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51516766 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 630900020 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 630903020 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 630906020 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51516762 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51516770 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 630901020 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 630902020 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 630908020 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201117 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102I67971 . This is a "MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51083037 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51516767 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51516769 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com