1679806905 NPI number — MEDICAL RESOURCES, INC.

Table of content: (NPI 1679806905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679806905 NPI number — MEDICAL RESOURCES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL RESOURCES, INC.
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:
1679806905
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1511 4TH AVE S
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:
35233-1612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-521-7337
Provider Business Mailing Address Fax Number:
205-521-0585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 GOVERNORS DR SE
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35801-2728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-521-7337
Provider Business Practice Location Address Fax Number:
205-521-0585
Provider Enumeration Date:
09/18/2009

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
205-521-7337

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  900302 , 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: 009949560 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51097510 . This is a "BCBSAL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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