1144369075 NPI number — JULIE M VOLK

Table of content: JULIE M VOLK (NPI 1144369075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144369075 NPI number — JULIE M VOLK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VOLK
Provider First Name:
JULIE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1144369075
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7520
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPANISH FORT
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36577-7520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-626-9052
Provider Business Mailing Address Fax Number:
251-626-5384

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6475 VAN BUREN ST
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
DAPHNE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36526-7585
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-626-9052
Provider Business Practice Location Address Fax Number:
251-626-5384
Provider Enumeration Date:
02/06/2007

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: 225100000X , with the licence number:  PTH921 , 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: 51094062 . This is a "BCBS PT PROVIDER NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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