1861425621 NPI number — PHYSICIANS CHOICE DIALYSIS OF ALEXANDER CITY, LLC

Table of content: (NPI 1861425621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861425621 NPI number — PHYSICIANS CHOICE DIALYSIS OF ALEXANDER CITY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIANS CHOICE DIALYSIS OF ALEXANDER CITY, 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:
PCD ALEXANDER CITY
Provider Other Organization Name Type Code:
5
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:
1861425621
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 COMMERCE CT
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
POTTSTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19464-3483
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-495-8900
Provider Business Mailing Address Fax Number:
610-495-8560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3316 HIGHWAY 280 BYPASS
Provider Second Line Business Practice Location Address:
SUITE G1
Provider Business Practice Location Address City Name:
ALEXANDER CITY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35010-3369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-329-0638
Provider Business Practice Location Address Fax Number:
256-329-8934
Provider Enumeration Date:
07/07/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PALUMBO
Authorized Official First Name:
RHONDA
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
DIRECTOR OF CONTRACTS/HR
Authorized Official Telephone Number:
610-495-8900

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  12110 , 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: 012-502 . This is a "BLUE CROSS ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: DIA2617D , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".