1174829089 NPI number — CHARLES B. LOVELADY, M.D., L.L.C.

Table of content: (NPI 1174829089)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174829089 NPI number — CHARLES B. LOVELADY, M.D., L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLES B. LOVELADY, M.D., L.L.C.
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:
1174829089
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1050
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSBORO
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35768-1050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-218-3856
Provider Business Mailing Address Fax Number:
256-218-3536

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
509 BURLINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSBORO
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35768-4216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-259-4817
Provider Business Practice Location Address Fax Number:
256-259-2075
Provider Enumeration Date:
02/10/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LOVELADY
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL OFFICER
Authorized Official Telephone Number:
256-259-4817

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  MD13720 , 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: 51049416 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 112843 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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