1538255922 NPI number — ALABAMA DIGESTIVE DISEASES,P.C

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 1538255922 NPI number — ALABAMA DIGESTIVE DISEASES,P.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALABAMA DIGESTIVE DISEASES,P.C
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:
1538255922
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
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:
SUITE 307
Provider Business Mailing Address City Name:
BESSEMER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35022-4500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-481-7384
Provider Business Mailing Address Fax Number:
205-481-7389

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
985 9TH AVE SW
Provider Second Line Business Practice Location Address:
SUITE 307
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:
205-481-7384
Provider Business Practice Location Address Fax Number:
205-481-7389
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LUTTRELL
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
BUCK
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
205-481-7384

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , 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)





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