1033240601 NPI number — MS. CYNTHIA MILSTEAD NP

Table of content: MS. CYNTHIA MILSTEAD NP (NPI 1033240601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033240601 NPI number — MS. CYNTHIA MILSTEAD NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILSTEAD
Provider First Name:
CYNTHIA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

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:
1033240601
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1414 ELBA HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36079-6020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-670-6726
Provider Business Mailing Address Fax Number:
334-670-6731

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4300 W MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
DOTHAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36305-1054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-446-0076
Provider Business Practice Location Address Fax Number:
334-446-0203
Provider Enumeration Date:
03/08/2007

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: 363L00000X , with the licence number:  RN090178 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 1-144836 , 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: 181095 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1-144836 . This is a "STATE LICENSE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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