1376726125 NPI number — MONTGOMERY WOMEN'S HEALTH ASSOCIATES 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 1376726125 NPI number — MONTGOMERY WOMEN'S HEALTH ASSOCIATES P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTGOMERY WOMEN'S HEALTH ASSOCIATES 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:
1376726125
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2055 E SOUTH BLVD
Provider Second Line Business Mailing Address:
STE 209
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36116-2001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-281-1191
Provider Business Mailing Address Fax Number:
334-281-1940

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2055 E SOUTH BLVD
Provider Second Line Business Practice Location Address:
STE 209
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36116-2001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-281-1191
Provider Business Practice Location Address Fax Number:
334-281-1940
Provider Enumeration Date:
12/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCCLINTON
Authorized Official First Name:
JOE
Authorized Official Middle Name:
D
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
334-281-1191

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , 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: 0000010705 . This is a "BLUE CROSS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-000011527 . This is a "BLUE CROSS OF AL PROVIDER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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