1487690764 NPI number — ELAINE B ST JOHN M.D.

Table of content: ELAINE B ST JOHN M.D. (NPI 1487690764)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487690764 NPI number — ELAINE B ST JOHN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ST JOHN
Provider First Name:
ELAINE
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1487690764
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 55823
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:
35255-5823
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-996-2244
Provider Business Mailing Address Fax Number:
205-996-2254

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 NHB
Provider Second Line Business Practice Location Address:
619 SOUTH 19TH STREET
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35249-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-996-2244
Provider Business Practice Location Address Fax Number:
205-996-2254
Provider Enumeration Date:
06/22/2006

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: 2080N0001X , with the licence number:  11210 , 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: 00114023 . This is a "MISSISSIPPI MEDICAID" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 4710039 . This is a "UHC" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 510-17015 . This is a "BC BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: C76552 . This is a "VIVA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00485207X . This is a "GEORGIA MEDICAID" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 2218 . This is a "HEALTHSPRING" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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