1649265810 NPI number — ANESTHESIA SERVICES PC

Table of content: (NPI 1649265810)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649265810 NPI number — ANESTHESIA SERVICES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANESTHESIA SERVICES PC
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:
1649265810
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11407
Provider Second Line Business Mailing Address:
DEPT 1499
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35246-1499
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-897-6169
Provider Business Mailing Address Fax Number:
800-897-6170

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 MOBILE INFIRMARY CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36607-3513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-432-4497
Provider Business Practice Location Address Fax Number:
251-432-0577
Provider Enumeration Date:
09/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JORDAN
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
251-432-4497

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000060068 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: C068 . This is a "BC OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com