1790987725 NPI number — RIVER CITY ALLERGY & MEDICAL PA

Table of content: DR. LAUREN NICOLE FOX PHARMD, RPH (NPI 1578085288)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790987725 NPI number — RIVER CITY ALLERGY & MEDICAL PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVER CITY ALLERGY & MEDICAL PA
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:
1790987725
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 S MAIN ST STE 1300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38103-5513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-949-0108
Provider Business Mailing Address Fax Number:
256-547-9755

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 20TH ST N STE 2200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35203-3261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-949-0108
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/01/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
256-547-4971

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000740 . This is a "PTAN" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 040015339 . This is a "RAILROAD RETIREMENT MEDIC" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 051000740 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".