1629152822 NPI number — FAYETTE MEDICAL CENTER

Table of content: DR. NORMAN VINCENT GODFREY M.D. (NPI 1295774446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629152822 NPI number — FAYETTE MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAYETTE MEDICAL CENTER
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:
1629152822
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 710
Provider Second Line Business Mailing Address:
1653 TEMPLE AVENUE NORTH
Provider Business Mailing Address City Name:
FAYETTE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35555-0710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-932-5966
Provider Business Mailing Address Fax Number:
205-932-8054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 15TH STREET NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35555-1526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-932-8057
Provider Business Practice Location Address Fax Number:
205-932-8054
Provider Enumeration Date:
10/24/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HINDMAN
Authorized Official First Name:
KERI
Authorized Official Middle Name:
HENLEY
Authorized Official Title or Position:
PATIENT ACCOUNTS DIRECTOR
Authorized Official Telephone Number:
205-759-7378

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  11656 , 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: PIC1540E , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 011549 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".