1932183217 NPI number — WILLIAM CARROLL HIXSON MD

Table of content: WILLIAM CARROLL HIXSON MD (NPI 1932183217)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932183217 NPI number — WILLIAM CARROLL HIXSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HIXSON
Provider First Name:
WILLIAM
Provider Middle Name:
CARROLL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1932183217
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 40430
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36640-0430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-434-3626
Provider Business Mailing Address Fax Number:
251-445-2464

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1047 FAIRHOPE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRHOPE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36532-3145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-990-1850
Provider Business Practice Location Address Fax Number:
251-990-1851
Provider Enumeration Date:
12/01/2005

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: 2085R0001X , with the licence number:  MD.15856 , 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: 009946795 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051557246 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 510-46494 . This is a "BCBS DAPHNE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51032527 . This is a "BCBS FOLEY" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-33480 . This is a "BCBS GULF SHORES" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 000032526 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 990008217 . This is a "RR MEDICARE SARO" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: P00317625 . This is a "RR MEDICARE GS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 000032527 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 266724000 . This is a "ACS FL MEDICAID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-22793 . This is a "BCBS MONROEVILLE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51592672 . This is a "BCBS BREWTON" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: P00190938 . This is a "RR MEDICARE MNR" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 103733600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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