1508820440 NPI number — RENEE PAYNE FREEMAN CRNA

Table of content: (NPI 1255160719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508820440 NPI number — RENEE PAYNE FREEMAN CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREEMAN
Provider First Name:
RENEE
Provider Middle Name:
PAYNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FREEMAN
Provider Other First Name:
ANDREA
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1508820440
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2151 OLD ROCKY RIDGE RD STE 106
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VESTAVIA HILLS
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35216-7251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-989-1080
Provider Business Mailing Address Fax Number:
205-989-1087

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3316 HIGHWAY 280
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALEXANDER CITY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35010-3369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-329-7100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/17/2006

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: 367500000X , with the licence number:  1-047484 , 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: 430036754 . This is a "PALMETTO" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 595253125A . This is a "GA CAID" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 000032116 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".