1093487746 NPI number — BABYLON HEALTHCARE, PLLC

Table of content: (NPI 1376788505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093487746 NPI number — BABYLON HEALTHCARE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BABYLON HEALTHCARE, PLLC
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:
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:
1093487746
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1543
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78767-1543
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-475-6168
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1450 W PEACHTREE ST. NW #200
Provider Second Line Business Practice Location Address:
PMB 53059
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30309-2955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-475-6168
Provider Business Practice Location Address Fax Number:
855-943-1026
Provider Enumeration Date:
10/01/2021

Additional Information

Authorized Official

Authorized Official Last Name:
CHEN
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
LEGAL COUNSEL
Authorized Official Telephone Number:
800-475-6168

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0225357 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300051835 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1225357 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2225357 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 250008725 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3225357 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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