1457534612 NPI number — NEW BEACON HEALTHCARE GROUP, LLC

Table of content: (NPI 1457534612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457534612 NPI number — NEW BEACON HEALTHCARE GROUP, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW BEACON HEALTHCARE GROUP, 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:
1457534612
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2151 HIGHLAND AVE S
Provider Second Line Business Mailing Address:
SUITE 350
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35205-4079
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-939-8711
Provider Business Mailing Address Fax Number:
205-939-8778

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3511 SUMMERVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHENIX CITY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36867-2628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-939-8711
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MORRIS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CEO AND PRESIDENT
Authorized Official Telephone Number:
205-939-8711

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  APPLIED FOR , 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)





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