1467405787 NPI number — LISA M CHRISTIAN MD

Table of content: LISA M CHRISTIAN MD (NPI 1467405787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467405787 NPI number — LISA M CHRISTIAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHRISTIAN
Provider First Name:
LISA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MINGE
Provider Other First Name:
LISA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1467405787
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 S MONTGOMERY AVE
Provider Second Line Business Mailing Address:
SUITE 259
Provider Business Mailing Address City Name:
SHEFFIELD
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35660-6330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-383-3372
Provider Business Mailing Address Fax Number:
256-386-7109

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 SOUTH MONTGOMERY AVE
Provider Second Line Business Practice Location Address:
SUITE 259
Provider Business Practice Location Address City Name:
SHEFFIELD
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-383-3372
Provider Business Practice Location Address Fax Number:
256-386-7109
Provider Enumeration Date:
05/18/2006

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: 207V00000X , with the licence number:  M8994 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VX0000X , with the licence number: MD.33730 , 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: 000010145128 . This is a "BLUE SHIELD" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 57232 . This is a "BLUE CROSS" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 806742900 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".




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