1821101320 NPI number — HEMATOLOGY AND ONCOLOGY ASSOCIATES OF ALABAMA, LLC

Table of content: (NPI 1821101320)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821101320 NPI number — HEMATOLOGY AND ONCOLOGY ASSOCIATES OF ALABAMA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEMATOLOGY AND ONCOLOGY ASSOCIATES OF ALABAMA, 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:
1821101320
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 131329
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:
35213-6329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-271-8541
Provider Business Mailing Address Fax Number:
205-271-8541

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
209 W SPRING ST
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
SYLACAUGA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35150-2973
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-401-0417
Provider Business Practice Location Address Fax Number:
256-401-0421
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CASTILLO
Authorized Official First Name:
ELQUIS
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
205-271-8541

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 529912150 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: CK5459 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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