1184759243 NPI number — SUZANNE L HERRIN PA

Table of content: SUZANNE L HERRIN PA (NPI 1184759243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184759243 NPI number — SUZANNE L HERRIN PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERRIN
Provider First Name:
SUZANNE
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LIVINGOOD
Provider Other First Name:
SUZANNE
Provider Other Middle Name:
ELISE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184759243
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 55310
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:
35255-5310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-731-9701
Provider Business Mailing Address Fax Number:
205-297-9411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 6TH AVE S
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:
35233-2110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-801-8000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/22/2007

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: 363AM0700X , with the licence number:  004979 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PA 719 , 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: 051111212 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051111213 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 261470131A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08488856 . This is a "MEDICAID OF MISSISSIPPI" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 08488856 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 124578 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051111214 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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