1427224856 NPI number — MAIC PC

Table of content: (NPI 1427224856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427224856 NPI number — MAIC PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAIC PC
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:
MEMPHIS ACCIDENT AND INJURY CENTER
Provider Other Organization Name Type Code:
3
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:
1427224856
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7461
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JUPITER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33468
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-649-4662
Provider Business Mailing Address Fax Number:
561-649-4665

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1509 UNION AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-278-5156
Provider Business Practice Location Address Fax Number:
901-278-5161
Provider Enumeration Date:
05/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BYRD
Authorized Official First Name:
ROGER
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
SEC
Authorized Official Telephone Number:
561-649-4662

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1470 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X , with the licence number: APN0000005344 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: 11736 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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