1427105675 NPI number — DR. SUSAN M FERGUSON M.D.

Table of content: DR. SUSAN M FERGUSON M.D. (NPI 1427105675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427105675 NPI number — DR. SUSAN M FERGUSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERGUSON
Provider First Name:
SUSAN
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1427105675
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1024 1ST ST N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALABASTER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35007-8703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-664-4051
Provider Business Mailing Address Fax Number:
205-664-4054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1024 1ST ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALABASTER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35007-8703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-664-4051
Provider Business Practice Location Address Fax Number:
205-664-4054
Provider Enumeration Date:
01/03/2007

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: 207RX0202X , with the licence number:  4175 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: 4175 , 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: 051519329 . This is a "BCBS PROVIDER ID" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 752974799 . This is a "TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00120269 . This is a "RAILROAD MEDICARE/PGBA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 108623 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009940155 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 26-4105002 . This is a "TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 510-48638 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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