1508856352 NPI number — EICH PLASTIC SURGERY PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508856352 NPI number — EICH PLASTIC SURGERY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EICH PLASTIC SURGERY PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1508856352
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 PILOT MEDICAL DRIVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35235-3462
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-856-6155
Provider Business Mailing Address Fax Number:
205-856-9391

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 PILOT MEDICAL DRIVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35235-3462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-856-6155
Provider Business Practice Location Address Fax Number:
205-856-9391
Provider Enumeration Date:
10/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
EICH
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
SHELBY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
205-856-6155

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  17710 , 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: 009975650 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: F78813 . This is a "VIVA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 43438 . This is a "THE OATH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 51505077 . This is a "BC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1310081 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".




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