1134494685 NPI number — CULLMAN HEART & URGENT CARE PC

Table of content: DR. JENNIFER ROOT MAYER M.D. (NPI 1770534802)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134494685 NPI number — CULLMAN HEART & URGENT CARE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CULLMAN HEART & URGENT CARE 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:
1134494685
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1801 PARK VIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CULLMAN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35058-3618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-775-6550
Provider Business Mailing Address Fax Number:
256-775-6772

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1803 PARK VIEW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CULLMAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35058-3618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-255-1900
Provider Business Practice Location Address Fax Number:
256-255-1937
Provider Enumeration Date:
03/16/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VARQUEZ
Authorized Official First Name:
MIR
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
256-775-6550

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  17814 , 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: 1649334301 . This is a "OTHER GROUP NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 529802590 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".