1811171853 NPI number — TRI CITY PT CARE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811171853 NPI number — TRI CITY PT CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRI CITY PT CARE
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:
1811171853
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 LEIGHTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANNISTON
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36207-5743
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-240-7268
Provider Business Mailing Address Fax Number:
256-240-7334

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40745 HIGHWAY 77
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36251-4807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-354-3066
Provider Business Practice Location Address Fax Number:
256-354-3080
Provider Enumeration Date:
12/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KAMRAN
Authorized Official First Name:
MOHAMMAD
Authorized Official Middle Name:
Authorized Official Title or Position:
SOLE MEMBER
Authorized Official Telephone Number:
256-238-1154

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  084537 , 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)





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