1558779736 NPI number — PREFERRED PAIN ASSOCIATES OF ALABAMA, P.C.

Table of content: (NPI 1558779736)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558779736 NPI number — PREFERRED PAIN ASSOCIATES OF ALABAMA, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREFERRED PAIN ASSOCIATES OF ALABAMA, 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:
1558779736
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5057 PINNACLE SQ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35235-3216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-508-5300
Provider Business Mailing Address Fax Number:
205-508-5552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5057 PINNACLE SQ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35235-3216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-508-5300
Provider Business Practice Location Address Fax Number:
205-508-5552
Provider Enumeration Date:
07/31/2014

Additional Information

Authorized Official

Authorized Official Last Name:
FRENETTE
Authorized Official First Name:
JOSEPH ROLAND
Authorized Official Middle Name:
LUC
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
205-508-5300

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  16051 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP2900X , with the licence number: AL16501 , 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: 000083967 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051511180 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 2674 . This is a "HEALTH SPRING OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 00127023 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000083967 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010033CE88731 . This is a "SECTION 1011" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: E88731 . This is a "VIVA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 050045678 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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