1528317849 NPI number — EAST ALABAMA SPECIALTY THERAPY CLINIC, LLC

Table of content: (NPI 1528317849)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528317849 NPI number — EAST ALABAMA SPECIALTY THERAPY CLINIC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST ALABAMA SPECIALTY THERAPY CLINIC, LLC
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:
EAST CLINIC
Provider Other Organization Name Type Code:
3
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:
1528317849
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2415 MOORES MILL RD
Provider Second Line Business Mailing Address:
SUITE 265-128
Provider Business Mailing Address City Name:
AUBURN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36830-8480
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-759-0111
Provider Business Mailing Address Fax Number:
334-521-7251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1805 RAYMER PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36830-2187
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-759-0111
Provider Business Practice Location Address Fax Number:
334-521-7251
Provider Enumeration Date:
08/31/2012

Additional Information

Authorized Official

Authorized Official Last Name:
LOMBARDO
Authorized Official First Name:
JENNIE
Authorized Official Middle Name:
BELLE
Authorized Official Title or Position:
CEO MANAGER
Authorized Official Telephone Number:
334-759-0111

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com