1578593653 NPI number — HENRY WADE FAULKNER M.D.

Table of content: HENRY WADE FAULKNER M.D. (NPI 1578593653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578593653 NPI number — HENRY WADE FAULKNER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FAULKNER
Provider First Name:
HENRY
Provider Middle Name:
WADE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1578593653
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 STATE FARM PKWY
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:
35209-7181
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-943-4650
Provider Business Mailing Address Fax Number:
205-943-4688

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3290 DAUPHIN ST
Provider Second Line Business Practice Location Address:
SUITE 401
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36606-4062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-471-3309
Provider Business Practice Location Address Fax Number:
251-471-5046
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  3688 , 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: 1578593653 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 515-19305 . This is a "BC-3290 DAUPHIN ST, SUITE 401, MOBILE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-47835 . This is a "BC-6801 AIRPORT BLVD, MOBILE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 699543 . This is a "FIRST HEALTH" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: P00085469 . This is a "RR MEDICARE PGBA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 515-47838 . This is a "BC-750 MORPHY AVE, FAIRHOPE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 770610758 . This is a "HEALTHCHOICE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051519305 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 510-10235 . This is a "BC-2003 MEDICAL CENTER DR, BAY MINETTE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-47834 . This is a "BC-1815 HAND AVE, BAY MINETTE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-47837 . This is a "BC-3719 DAUPHIN ST, MOBILE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: C75158 . This is a "HEALTHSPRING" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051519305 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0810058 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 510-10216 . This is a "BC-7101 US HWY 90, DAPHNE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: C75158 . This is a "SENIORS FIRST" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 510-10218 . This is a "BC-1811 HAND AVE, BAY MINETTE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-47032 . This is a "BC-6144 A AIRPORT BLVD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-47836 . This is a "BC-5 MOBILE INFIRMARY CIRCLE, MOBILE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: C75158 . This is a "VIVA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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