1114308335 NPI number — ROSEMARIE CAILLIER, DPM, PC

Table of content: (NPI 1114308335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114308335 NPI number — ROSEMARIE CAILLIER, DPM, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROSEMARIE CAILLIER, DPM, PC
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:
1114308335
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3546 BROOK HIGHLAND DR
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:
35406-2952
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-409-0175
Provider Business Mailing Address Fax Number:
205-764-5937

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2002 MCFARLAND BLVD E
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
TUSCALOOSA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35404-5856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-409-0175
Provider Business Practice Location Address Fax Number:
205-764-5800
Provider Enumeration Date:
06/12/2015

Additional Information

Authorized Official

Authorized Official Last Name:
CAILLIER
Authorized Official First Name:
ROSEMARIE
Authorized Official Middle Name:
JACK
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
585-203-7486

Provider Taxonomy Codes

  • Taxonomy code: 213EP1101X , with the licence number:  313 , 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: 187474 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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