1376693606 NPI number — RHEUMATOLOGY AND ARTHRITIS CLINIC, P.C

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 1376693606 NPI number — RHEUMATOLOGY AND ARTHRITIS CLINIC, P.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RHEUMATOLOGY AND ARTHRITIS CLINIC, 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:
1376693606
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 WHITESPORT DR SW STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35801-6429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-880-4077
Provider Business Mailing Address Fax Number:
256-880-5277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 WHITESPORT DR SW STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35801-6429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-880-4077
Provider Business Practice Location Address Fax Number:
256-880-5277
Provider Enumeration Date:
01/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JAMPALA
Authorized Official First Name:
VIJAYANARAYANA
Authorized Official Middle Name:
RAO
Authorized Official Title or Position:
OWNER/MD
Authorized Official Telephone Number:
256-880-4077

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X , with the licence number:  00026049 , 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)





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