1538211024 NPI number — KELLEY SNOW MD 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 1538211024 NPI number — KELLEY SNOW MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KELLEY SNOW MD 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:
1538211024
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
985 9TH AVE SW
Provider Second Line Business Mailing Address:
STE. 507
Provider Business Mailing Address City Name:
BESSEMER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35022-7814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-481-7577
Provider Business Mailing Address Fax Number:
205-481-7580

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
985 9TH AVE SW
Provider Second Line Business Practice Location Address:
STE. 507
Provider Business Practice Location Address City Name:
BESSEMER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35022-4500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-481-7577
Provider Business Practice Location Address Fax Number:
205-481-7580
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SNOW
Authorized Official First Name:
KELLEY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER/SURGEON
Authorized Official Telephone Number:
205-481-7577

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  9110 , 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: 006433 . This is a "MEDICARE RAILROAD GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000018743 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200041630 . This is a "MEDICARE RAILROAD IND." identifier . This identifiers is of the category "OTHER".




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