1831146901 NPI number — DR. ELIZABETH R WEATHERFORD M.D.

Table of content: DR. ELIZABETH R WEATHERFORD M.D. (NPI 1831146901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831146901 NPI number — DR. ELIZABETH R WEATHERFORD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEATHERFORD
Provider First Name:
ELIZABETH
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1831146901
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 298
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35631-0298
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-767-7494
Provider Business Mailing Address Fax Number:
256-760-8432

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1404 E AVALON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUSCUMBIA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35674-1773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-381-4400
Provider Business Practice Location Address Fax Number:
256-381-4783
Provider Enumeration Date:
05/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  00015778 , 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: 515-31111 . This is a "BCBS-401 COLLEGE FLO, AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009939493 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51515569 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51509167WEA . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51536614 . This is a "BCBS-WINFIELD, AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51537209 . This is a "2030 CHESTNUT, MONTGOMERY" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051509167 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 631053058013 . This is a "TRICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009939496 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51536676 . This is a "BCBS-ARDMORE, AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51536677 . This is a "BCBS-ATHENS, AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51537005 . This is a "BCBS-RUSSELLVILLE 15225" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-38566 . This is a "BCBS-CENTRE, AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009939494 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009939497 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51536678 . This is a "BCBS-CALERA, AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51536928 . This is a "BCBS-4831 SPARKMAN DR" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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