1497885339 NPI number — DR. CHRISTOPHER A PARK M.D.

Table of content: DR. CHRISTOPHER A PARK M.D. (NPI 1497885339)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497885339 NPI number — DR. CHRISTOPHER A PARK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARK
Provider First Name:
CHRISTOPHER
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1497885339
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3700 DAUPHIN ST STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36608-1725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-340-6600
Provider Business Mailing Address Fax Number:
251-479-7164

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3700 DAUPHIN ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36608-1725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-340-6600
Provider Business Practice Location Address Fax Number:
251-479-7164
Provider Enumeration Date:
03/07/2007

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: 2086S0105X , with the licence number:  2007-00401 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0122X , with the licence number: 2007-00401 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0122X , with the licence number: 0101241162 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208200000X , with the licence number: 0101241162 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2082S0099X , with the licence number: 2007-00401 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2082S0099X , with the licence number: 0101241162 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208200000X , with the licence number: 2007-00401 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3810009016 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 510I240012 . This is a "RAILROAD MEDICARE PTAN" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 202030 . This is a "MEDCOST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 146F9 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 810641 . This is a "PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9897073 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 510I240012 . This is a "MEDICARE PTAN" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51595045 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 5906699 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q0040L , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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