1548359466 NPI number — TOWN OF CLAYTON

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 1548359466 NPI number — TOWN OF CLAYTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF CLAYTON
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:
6
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:
1548359466
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/15/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 601
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLAYTON
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36016-0601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-775-3356
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 S MIDWAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAYTON
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-775-3365
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GULLEDGE
Authorized Official First Name:
KERRY
Authorized Official Middle Name:
P
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
334-775-3365

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  178 , 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: 510-51859 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 000051859 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590007552 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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