1093792863 NPI number — 02 NEAL MEDICAL, INC.

Table of content: (NPI 1093792863)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093792863 NPI number — 02 NEAL MEDICAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
02 NEAL MEDICAL, INC.
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:
1093792863
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
240 CAHABA VALLEY PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PELHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35124-2212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-989-9902
Provider Business Mailing Address Fax Number:
205-989-9903

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
240 CAHABA VALLEY PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PELHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35124-2212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-989-9902
Provider Business Practice Location Address Fax Number:
205-989-9903
Provider Enumeration Date:
12/22/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ONEAL
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
205-989-9902

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 900464 , 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: 009925455 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51514676NE . This is a "BCBSAL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".