1780798108 NPI number — SOUTHERN HEALTH ASSOCIATES LLC

Table of content: (NPI 1780798108)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780798108 NPI number — SOUTHERN HEALTH ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN HEALTH ASSOCIATES LLC
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:
1780798108
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 S FRANKLIN DR
Provider Second Line Business Mailing Address:
P O BOX 1185
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36081-3838
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-566-9800
Provider Business Mailing Address Fax Number:
334-566-3700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 S FRANKLIN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36081-3838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-566-9800
Provider Business Practice Location Address Fax Number:
334-566-3700
Provider Enumeration Date:
08/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PEARLSTEIN
Authorized Official First Name:
TODD
Authorized Official Middle Name:
BARRY
Authorized Official Title or Position:
DR
Authorized Official Telephone Number:
334-566-9800

Provider Taxonomy Codes

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

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

  • Identifier: 000046153 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000046154 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 511-26794 . This is a "BLUE CROSS PROVIDER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 000046154 . This is a "DR TODD PEARLSTEIN MEDICARE PROVDIER NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51046154 . This is a "BLUECROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051551412 . This is a "BLUE CROSS STACIE JONES C" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51046153 . This is a "DR.PAMELA TRANTHAM" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: CG0951 . This is a "RR MEDICARE GROUP #" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 000046153 . This is a "DR TRANTH AM MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 102I082149 . This is a "DR ERIC LAW PTAN MEDICARE NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 529903890 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00213239 . This is a "RR MEDICARE STACIE JONESC" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 891004000 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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