1770891541 NPI number — JULIA BOEHME

Table of content: JULIA BOEHME (NPI 1770891541)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770891541 NPI number — JULIA BOEHME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOEHME
Provider First Name:
JULIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1770891541
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 MONROE ST
Provider Second Line Business Mailing Address:
SUITE 1386
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36104-3735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-206-7959
Provider Business Mailing Address Fax Number:
334-206-3998

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 CHERRY ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35601-1970
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-560-6507
Provider Business Practice Location Address Fax Number:
256-340-9823
Provider Enumeration Date:
09/15/2010

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: 363LF0000X , with the licence number:  1-056716 , 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)