1780648881 NPI number — BHC - HUEYTOWN

Table of content: (NPI 1780648881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780648881 NPI number — BHC - HUEYTOWN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BHC - HUEYTOWN
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:
1780648881
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 830605
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:
35283-0605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-715-5904
Provider Business Mailing Address Fax Number:
205-715-5928

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 ALLISON BONNETT MEMORIAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUEYTOWN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35023-1845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-744-4410
Provider Business Practice Location Address Fax Number:
205-744-6150
Provider Enumeration Date:
04/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FENN
Authorized Official First Name:
G.
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
CHIEF INTEGRATION OFFICER
Authorized Official Telephone Number:
205-715-5415

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 529402430 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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