1386849669 NPI number — BROOKWOOD OPHTHALMOLOGY IMAGING AND ANCILLARY SERVICES

Table of content: (NPI 1386849669)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386849669 NPI number — BROOKWOOD OPHTHALMOLOGY IMAGING AND ANCILLARY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROOKWOOD OPHTHALMOLOGY IMAGING AND ANCILLARY SERVICES
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:
1386849669
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 CHASE CORPORATE DR STE 439
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOOVER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35244-1026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-313-6300
Provider Business Mailing Address Fax Number:
253-645-4859

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 CHASE CORPORATE DR STE 439
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOOVER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35244-1026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-313-6300
Provider Business Practice Location Address Fax Number:
253-465-4859
Provider Enumeration Date:
06/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
JANIE
Authorized Official Middle Name:
NORFLEET
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
205-383-9498

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 51533857 . This is a "BCBS MARION" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051533202 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51533202 . This is a "BCBS AL BROOKWOOD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: P00301433 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 4648847 . This is a "AETNA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: A96597 . This is a "VIVA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009936633 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 213985282 . This is a "TRICARE STANDARD HUMANA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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