1730129016 NPI number — DR. PAIGE C. ROY MD

Table of content: DR. PAIGE C. ROY MD (NPI 1730129016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730129016 NPI number — DR. PAIGE C. ROY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROY
Provider First Name:
PAIGE
Provider Middle Name:
C.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CALHOUN
Provider Other First Name:
PAIGE
Provider Other Middle Name:
E.
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730129016
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 BRIGADOON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35757-8735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-514-2514
Provider Business Mailing Address Fax Number:
256-270-9980

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4704 WHITESBURG DR SW
Provider Second Line Business Practice Location Address:
SUITE #201
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35802-1679
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-270-9979
Provider Business Practice Location Address Fax Number:
256-270-9980
Provider Enumeration Date:
06/07/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  49051 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X , with the licence number: MD.28175 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208100000X , with the licence number: 2007-00412 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X , with the licence number: 059187 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 051543047 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009911110 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009911111 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".