1134176894 NPI number — ALL SOUTH SERVICES, INC

Table of content: (NPI 1134176894)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134176894 NPI number — ALL SOUTH SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALL SOUTH SERVICES, 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:
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:
1134176894
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4007
Provider Second Line Business Mailing Address:
1667 SHUG JORDAN PKWY SUITE 403
Provider Business Mailing Address City Name:
AUBURN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36831-4007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-821-2006
Provider Business Mailing Address Fax Number:
334-821-2033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1667 SHUG JORDAN PKWY
Provider Second Line Business Practice Location Address:
SUITE 403
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-821-2006
Provider Business Practice Location Address Fax Number:
334-821-2033
Provider Enumeration Date:
05/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHIFLETT
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
334-821-2006

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , 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: 2000838740A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00440957 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9001248500 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: DE2926 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4582326 . This is a "TENN CARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4944218 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51098336 . This is a "BCBS PROVIDER ID" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 52882970 . This is a "BCBS PROVIDER ID" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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