1023319563 NPI number — ROBERT J SCIACCA MD PC

Table of content: (NPI 1023319563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023319563 NPI number — ROBERT J SCIACCA MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT J SCIACCA MD PC
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:
1023319563
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4515 SOUTHLAKE PKWY
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35244-3317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-985-7393
Provider Business Mailing Address Fax Number:
205-987-1332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4515 SOUTHLAKE PKWY
Provider Second Line Business Practice Location Address:
STE 300
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35244-3317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-985-7393
Provider Business Practice Location Address Fax Number:
205-987-1332
Provider Enumeration Date:
11/16/2010

Additional Information

Authorized Official

Authorized Official Last Name:
POLLARD
Authorized Official First Name:
LATARA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
205-985-7393

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  8954 , 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: 51104671 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 040004918 . This is a "MCRRR" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 118134 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 167432400 . This is a "OWCP" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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