1205833761 NPI number — CHARLES MICHAEL MEAD MD

Table of content: CHARLES MICHAEL MEAD MD (NPI 1205833761)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205833761 NPI number — CHARLES MICHAEL MEAD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEAD
Provider First Name:
CHARLES
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1205833761
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
502 MONTGOMERY HWY
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35216-1862
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-823-0882
Provider Business Mailing Address Fax Number:
205-823-0872

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
502 MONTGOMERY HWY
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
VESTAVIA HILLS
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35216-1863
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-823-0882
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/30/2005

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: 2085R0202X , with the licence number:  00017189 , 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: 051555108 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051531044 . This is a "MEDICARE - GARDENDALE PHYSICIAN ASSOC." identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051531585 . This is a "MEDICARE - NORTH JEFFERSON IMAGING, LLC" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051540087 . This is a "MEDICARE - HORIZON IMAGING, PC" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: P00189169 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 51524439 . This is a "BCBS AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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