1326161332 NPI number — DR. CHAD ELLIOTT HARBIN D.O.

Table of content: DR. CHAD ELLIOTT HARBIN D.O. (NPI 1326161332)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326161332 NPI number — DR. CHAD ELLIOTT HARBIN D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARBIN
Provider First Name:
CHAD
Provider Middle Name:
ELLIOTT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1326161332
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2006 FRANKLIN ST SE
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35801-4551
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-539-9471
Provider Business Mailing Address Fax Number:
256-539-9472

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2006 FRANKLIN ST SE STE 301
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35801-4537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-539-9471
Provider Business Practice Location Address Fax Number:
256-539-9472
Provider Enumeration Date:
04/06/2007

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: 207L00000X , with the licence number:  DO884 , 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: 0511-43228 . This is a "BLUE CROSS BLUE SHIELD OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1326161332 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1326161332 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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