1154448652 NPI number — DR. EVANS CECIL BAILEY MD, PHD

Table of content: DR. EVANS CECIL BAILEY MD, PHD (NPI 1154448652)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154448652 NPI number — DR. EVANS CECIL BAILEY MD, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAILEY
Provider First Name:
EVANS
Provider Middle Name:
CECIL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, PHD
Provider Gender Code:
M

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:
1154448652
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 CONCOURSE PKWY
Provider Second Line Business Mailing Address:
SUITE 265
Provider Business Mailing Address City Name:
HOOVER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35244-1881
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-453-4195
Provider Business Mailing Address Fax Number:
205-533-7385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 CONCOURSE PKWY
Provider Second Line Business Practice Location Address:
SUITE 265
Provider Business Practice Location Address City Name:
HOOVER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35244-1881
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-453-4195
Provider Business Practice Location Address Fax Number:
205-533-7385
Provider Enumeration Date:
03/22/2007

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: 207N00000X , with the licence number:  4301085209 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X , with the licence number: 4301085209 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207N00000X , with the licence number: 26882 , 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: 5315021127 . This is a "CONTROLLED SUBSTANCE LICE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 511-01156 . This is a "BCBS AL HSV" identifier . This identifiers is of the category "OTHER".
  • Identifier: 511-01155 . This is a "BCBS AL MGM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 511-01154 . This is a "BCBS AL BHAM" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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