1386972990 NPI number — PRIMARY CARE SERVICES OF SHELBY, INC.

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 1386972990 NPI number — PRIMARY CARE SERVICES OF SHELBY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIMARY CARE SERVICES OF SHELBY, INC.
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:
1386972990
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1919 OXMOOR RD
Provider Second Line Business Mailing Address:
SUITE 212
Provider Business Mailing Address City Name:
HOMEWOOD
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35209-3502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-470-7281
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1919 OXMOOR RD
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
HOMEWOOD
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35209-3502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-470-7281
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LAZO
Authorized Official First Name:
JORGE
Authorized Official Middle Name:
JIMENEZ
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
205-470-7281

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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