1154725265 NPI number — G & G MEDICAL CARE INC.

Table of content: (NPI 1154725265)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154725265 NPI number — G & G MEDICAL CARE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
G & G MEDICAL CARE 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:
6
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:
1154725265
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 HELENA MARKET PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HELENA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35080-3395
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-685-4870
Provider Business Mailing Address Fax Number:
205-685-4869

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5152 COLONIAL PARK RD
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:
35242-3264
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-685-4870
Provider Business Practice Location Address Fax Number:
205-685-4869
Provider Enumeration Date:
10/17/2014

Additional Information

Authorized Official

Authorized Official Last Name:
STANFORD
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
205-685-4870

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 102G705775 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 01D2085824 . This is a "CLIA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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