1972608941 NPI number — EASTER SEALS ALABAMA, INC. EASTER SEALS WEST ALABAMA

Table of content: (NPI 1972608941)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972608941 NPI number — EASTER SEALS ALABAMA, INC. EASTER SEALS WEST ALABAMA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTER SEALS ALABAMA, INC. EASTER SEALS WEST ALABAMA
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:
EASTER SEALS WEST ALABAMA
Provider Other Organization Name Type Code:
3
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:
1972608941
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2817
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUSCALOOSA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35403-2817
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-759-1211
Provider Business Mailing Address Fax Number:
205-349-1162

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1110 DR. EDWARD HILLARD DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUSCALOOSA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35401-3207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-759-1211
Provider Business Practice Location Address Fax Number:
205-349-1162
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSTON
Authorized Official First Name:
RONNY
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
205-759-1211

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X , with the licence number:  12008 , 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: 515-31066 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51531482 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 010-175 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 529101420 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010-175 . This is a "BCBS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51077985 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51515014 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51533901 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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