1366133449 NPI number — SRX LLC

Table of content: (NPI 1366133449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366133449 NPI number — SRX LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SRX LLC
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:
6
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:
1366133449
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106A SARALAND LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SARALAND
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36571-2436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-675-3333
Provider Business Mailing Address Fax Number:
251-675-9333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
306 S UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36609-2909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-675-3333
Provider Business Practice Location Address Fax Number:
251-675-9333
Provider Enumeration Date:
05/18/2023

Additional Information

Authorized Official

Authorized Official Last Name:
STINSON
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
251-675-3333

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 314400 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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