1144282856 NPI number — DR. PRINTELLA RIDGEWAY M.D.

Table of content: DR. PRINTELLA RIDGEWAY M.D. (NPI 1144282856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144282856 NPI number — DR. PRINTELLA RIDGEWAY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIDGEWAY
Provider First Name:
PRINTELLA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RIDGEWAY-THOMAS
Provider Other First Name:
PRINTELLA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1144282856
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 WEST BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35206-1300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-591-5180
Provider Business Mailing Address Fax Number:
205-510-3476

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 WEST BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35206-1300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-591-5180
Provider Business Practice Location Address Fax Number:
205-510-3476
Provider Enumeration Date:
04/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  11329 , 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: 303709079 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 510-65891 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 113217 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 303739079 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051032503 . This is a "BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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