1871575373 NPI number — DARELL E. SHOWS PA-C

Table of content: DARELL E. SHOWS PA-C (NPI 1871575373)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871575373 NPI number — DARELL E. SHOWS PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHOWS
Provider First Name:
DARELL
Provider Middle Name:
E.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

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:
1871575373
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5183
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERIDIAN
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39302-5183
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-703-4282
Provider Business Mailing Address Fax Number:
601-703-4597

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 12TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERIDIAN
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39301-4158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-703-4362
Provider Business Practice Location Address Fax Number:
601-703-6786
Provider Enumeration Date:
11/18/2005

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: 363AM0700X , with the licence number:  PA015 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 970030629 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 009914345 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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