1689852568 NPI number — KAMATH MEDICAL CLINIC MD PC

Table of content: EMILY GRACE RADER COTA (NPI 1376326454)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689852568 NPI number — KAMATH MEDICAL CLINIC MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KAMATH MEDICAL CLINIC MD 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:
1689852568
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
#1 MEDICAL PARK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALLEY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36854-3665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-756-2101
Provider Business Mailing Address Fax Number:
334-756-5820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
#1 MEDICAL PARK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALLEY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36854-3665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-756-2101
Provider Business Practice Location Address Fax Number:
334-756-5820
Provider Enumeration Date:
02/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KAMATH
Authorized Official First Name:
ARVIND
Authorized Official Middle Name:
PANDURANG
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
334-756-2101

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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