1245224294 NPI number — CAHABA PATHOLOGY

Table of content: (NPI 1245224294)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245224294 NPI number — CAHABA PATHOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAHABA PATHOLOGY
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:
1245224294
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11407
Provider Second Line Business Mailing Address:
DRAWER 1238
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35246-0100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-897-6169
Provider Business Mailing Address Fax Number:
800-897-6170

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
644 2ND ST NE
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
ALABASTER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35007-8824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-620-3329
Provider Business Practice Location Address Fax Number:
205-664-4322
Provider Enumeration Date:
09/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CANTLEY
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
205-620-3329

Provider Taxonomy Codes

  • Taxonomy code: 207ZD0900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: F883 . This is a "GROUP # BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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