1396462578 NPI number — IRON CITY PSYCHIATRY, LLC

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 1396462578 NPI number — IRON CITY PSYCHIATRY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IRON CITY PSYCHIATRY, 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:
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:
1396462578
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5601 11TH AVE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35222-4137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-469-2387
Provider Business Mailing Address Fax Number:
205-719-4107

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 OFFICE PARK DR STE 316
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTAIN BRK
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35223-2456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-202-1865
Provider Business Practice Location Address Fax Number:
205-719-4107
Provider Enumeration Date:
10/27/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
HENRY
Authorized Official Title or Position:
SOLE MEMBER
Authorized Official Telephone Number:
843-469-2387

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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