1033745294 NPI number — WILLIAM JACKSON STEELE SR. MSN, CRNP, ACNPC-AG

Table of content: WILLIAM JACKSON STEELE SR. MSN, CRNP, ACNPC-AG (NPI 1033745294)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033745294 NPI number — WILLIAM JACKSON STEELE SR. MSN, CRNP, ACNPC-AG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEELE
Provider First Name:
WILLIAM
Provider Middle Name:
JACKSON
Provider Name Prefix Text:
Provider Name Suffix Text:
SR.
Provider Credential Text:
MSN, CRNP, ACNPC-AG
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:
1033745294
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2130 GLENDALE GDNS
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:
35401-5826
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHPORT
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35476-3360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-361-5291
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/19/2020

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: 363LG0600X , with the licence number:  1-133900 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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