1821824111 NPI number — THE SHOULDER OF THE CENTRAL GULF COAST, INC.

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 1821824111 NPI number — THE SHOULDER OF THE CENTRAL GULF COAST, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE SHOULDER OF THE CENTRAL GULF COAST, INC.
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:
1821824111
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 637
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAPHNE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36526-0637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-626-2199
Provider Business Mailing Address Fax Number:
251-626-2188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6801 THREE NOTCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36619-1641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-626-2199
Provider Business Practice Location Address Fax Number:
251-626-2188
Provider Enumeration Date:
09/12/2024

Additional Information

Authorized Official

Authorized Official Last Name:
CARR
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
PATRICK
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
251-250-9295

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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