1427008184 NPI number — DR. TYLER O'NEAL KIRBY MD

Table of content: MATTHEW STANSBERY COTA/L (NPI 1508560897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427008184 NPI number — DR. TYLER O'NEAL KIRBY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIRBY
Provider First Name:
TYLER
Provider Middle Name:
O'NEAL
Provider Name Prefix Text:
DR.
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:
1427008184
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2705
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:
35804-2705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-801-6048
Provider Business Mailing Address Fax Number:
256-801-6218

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 SIVLEY RD SW
Provider Second Line Business Practice Location Address:
SUITE 620
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35801-5134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-265-4600
Provider Business Practice Location Address Fax Number:
256-265-4651
Provider Enumeration Date:
05/11/2006

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: 207VX0201X , with the licence number:  ME95793 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VX0201X , with the licence number: MD.23784 , 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: 051530398 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009969155 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01335306 . This is a "RAILROAD PTAN" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051514743 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 155957 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009923185 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 511-44257 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051514740 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051514741 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051523912 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009923175 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00008044 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051514740 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102I986140 . This is a "MEDICARE PTAN" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009923165 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051514742 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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