1023112307 NPI number — MUHAMMAD EJAZ ATA

Table of content: MUHAMMAD EJAZ ATA (NPI 1023112307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023112307 NPI number — MUHAMMAD EJAZ ATA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ATA
Provider First Name:
MUHAMMAD
Provider Middle Name:
EJAZ
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1023112307
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 246
Provider Second Line Business Mailing Address:
6110 COUNTY ROAD 88
Provider Business Mailing Address City Name:
PISGAH
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35765-0246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-451-1250
Provider Business Mailing Address Fax Number:
256-451-1270

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6110 COUNTY ROAD 88
Provider Second Line Business Practice Location Address:
PISGAH MEDICAL CLINIC
Provider Business Practice Location Address City Name:
PISGAH
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-451-1250
Provider Business Practice Location Address Fax Number:
256-451-1270
Provider Enumeration Date:
09/08/2006

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: 207R00000X , with the licence number:  16386 , 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: 009910886 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110061830 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051523907 . This is a "BLUE CROSS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 000087667 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051087667 . This is a "BLUE CROSS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 529900820 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 541003864 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 541386401 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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