1609214485 NPI number — RSA MEDICAL LLC

Table of content: (NPI 1609214485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609214485 NPI number — RSA MEDICAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RSA MEDICAL LLC
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:
WOMEN'S HEALTH ASSOCIATES
Provider Other Organization Name Type Code:
3
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:
1609214485
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 CORPORATE DR
Provider Second Line Business Mailing Address:
P.O. BOX 380155
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35242-2723
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-788-5164
Provider Business Mailing Address Fax Number:
205-788-5167

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1925 AVENUE E
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:
35218-1619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-788-5164
Provider Business Practice Location Address Fax Number:
205-788-5167
Provider Enumeration Date:
06/13/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ASHFORD
Authorized Official First Name:
ROWELL
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
205-788-5164

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  21275 , 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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