1902836885 NPI number — CAHABA PODIATRY, INC.

Table of content: ANNE MARIE JACOBS (NPI 1780410951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902836885 NPI number — CAHABA PODIATRY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAHABA PODIATRY, 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:
6
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:
1902836885
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 273
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHELSEA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35043-0273
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-980-2005
Provider Business Mailing Address Fax Number:
205-980-6889

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5511 HIGHWAY 280
Provider Second Line Business Practice Location Address:
SUITE 124
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35242-6585
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-980-2005
Provider Business Practice Location Address Fax Number:
205-980-6889
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YEAGER-SMITH
Authorized Official First Name:
LORA
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
205-980-2005

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X , with the licence number:  161 , 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: 51046369 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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