1104940774 NPI number — HERBERT H. BOWDEN

Table of content: (NPI 1104940774)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104940774 NPI number — HERBERT H. BOWDEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HERBERT H. BOWDEN
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:
1104940774
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
656 HONEYCOMB RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRANT
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35747-9378
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-533-7881
Provider Business Mailing Address Fax Number:
256-539-3333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2010C FRANKLIN ST SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35801-4514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-539-9937
Provider Business Practice Location Address Fax Number:
256-539-3333
Provider Enumeration Date:
03/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BOWDEN
Authorized Official First Name:
HERBERT
Authorized Official Middle Name:
HORTON
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
256-539-9937

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  19260 , 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: CG4620 . This is a "RAILROAD MEDICARE GROUP #" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051009438 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 000026246 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com