1225208507 NPI number — EAST ALABAMA PSYCHIATRIC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225208507 NPI number — EAST ALABAMA PSYCHIATRIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST ALABAMA PSYCHIATRIC
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:
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:
1225208507
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4310
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OPELIKA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36803-4310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3320 SKYWAY DR
Provider Second Line Business Practice Location Address:
SUITE 801
Provider Business Practice Location Address City Name:
OPELIKA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36801-7137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-749-3411
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DUNSON
Authorized Official First Name:
ASHLEY
Authorized Official Middle Name:
NICHOLE
Authorized Official Title or Position:
FINANCIAL SYSTEMS COORDINATOR
Authorized Official Telephone Number:
334-528-1387

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: I376 . This is a "MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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