1215124557 NPI number — BILL S NOLAND JR. CRNP

Table of content: BILL S NOLAND JR. CRNP (NPI 1215124557)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215124557 NPI number — BILL S NOLAND JR. CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOLAND
Provider First Name:
BILL
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
CRNP
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:
1215124557
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2609 VILLAGE PROFESSIONAL DR
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
OPELIKA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36801-4785
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-749-6523
Provider Business Mailing Address Fax Number:
334-742-0242

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2609 VILLAGE PROFESSIONAL DR
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
OPELIKA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36801-4785
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-749-6523
Provider Business Practice Location Address Fax Number:
334-742-0242
Provider Enumeration Date:
10/01/2007

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: 163WN0300X , with the licence number:  1-041332 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 2716 , 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: 1215124557 . This is a "NPI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 122759 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 122762 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1134289580 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 528701590 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1215124557 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 122761 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 122756 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 122765 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: CC1726 . This is a "RRMC" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 122760 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com