1477525970 NPI number — STEPHEN E SANDWELL MD

Table of content: STEPHEN E SANDWELL MD (NPI 1477525970)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477525970 NPI number — STEPHEN E SANDWELL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANDWELL
Provider First Name:
STEPHEN
Provider Middle Name:
E
Provider Name Prefix Text:
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:
1477525970
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 GOVERNORS DR SW FL 1
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:
35801-5171
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-533-1600
Provider Business Mailing Address Fax Number:
565-390-8562

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 GOVERNORS DR SW FL 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-533-1600
Provider Business Practice Location Address Fax Number:
256-539-0856
Provider Enumeration Date:
02/07/2006

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: 363AS0400X , with the licence number:  PA722 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207T00000X , with the licence number: 281802-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207T00000X , with the licence number: 37118 , 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: 216388 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 970028451 . This is a "RR MCARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 216728 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000243993 . This is a "BCBS PIN #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 216493 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9500292900 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".