1801089875 NPI number — HEMOPHILIA INFUSION MANAGERS LLC

Table of content: MS. JENNIFER ANN WALTERS CNM (NPI 1215287917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801089875 NPI number — HEMOPHILIA INFUSION MANAGERS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEMOPHILIA INFUSION MANAGERS 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:
6
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:
1801089875
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3142 1ST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOXLEY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36551-4569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-964-8885
Provider Business Mailing Address Fax Number:
251-964-8886

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3142 1ST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOXLEY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36551-4569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-964-8885
Provider Business Practice Location Address Fax Number:
251-964-8886
Provider Enumeration Date:
08/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOSLEY
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
251-459-2256

Provider Taxonomy Codes

  • Taxonomy code: 3336S0011X , with the licence number:  112979 , 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)

  • Identifier: 0134736 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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