1023122983 NPI number — CHARLES J DISKIN MD

Table of content: CHARLES J DISKIN MD (NPI 1023122983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023122983 NPI number — CHARLES J DISKIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DISKIN
Provider First Name:
CHARLES
Provider Middle Name:
J
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:
1023122983
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2609 VILLAGE PROFESSIONAL DR
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
OPELIKA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36801-5442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-749-6523
Provider Business Mailing Address Fax Number:
334-742-0242

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2609 VILLAGE PROFESSIONAL DR
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
OPELIKA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36801-5442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-749-6523
Provider Business Practice Location Address Fax Number:
334-742-0242
Provider Enumeration Date:
08/18/2006

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:  104691 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X , with the licence number: 104691 , 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: 000010756 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51088816 . This is a "BCBS LANGDALE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009919305 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009948995 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51086405 . This is a "BCBS TUSKEGEE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 000088816 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009948975 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 125726 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51520914 . This is a "BCBS AUBURN" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009948985 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: CC1726 . This is a "RRRMC" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1023122983 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 125727 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51088820 . This is a "BCBS DADEVILLE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 000086405 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51010756 . This is a "BCBS LAFAYETTE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51010757 . This is a "BCBS OPELIKA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 528701590 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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