1366555013 NPI number — TAMMY V GARRETT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366555013 NPI number — TAMMY V GARRETT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAMMY V GARRETT
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:
1366555013
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11234 DRENNEN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TANNER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35671-3622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-232-6588
Provider Business Mailing Address Fax Number:
256-232-6589

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11964 ESCUE DR STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TANNER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35671-3680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-232-6588
Provider Business Practice Location Address Fax Number:
256-232-6589
Provider Enumeration Date:
08/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GARRETT
Authorized Official First Name:
TAMMY
Authorized Official Middle Name:
V
Authorized Official Title or Position:
OWNER/PIC
Authorized Official Telephone Number:
256-232-6588

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  111155 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 11095 , 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: 0127755 . This is a "NCPDP" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51099925 . This is a "BCBS DME" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009985880 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100002934 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com