1467407999 NPI number — DR. ANTHONY N SODD MD

Table of content: DR. DAVID ROY WIGGINS O.D. (NPI 1346436334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467407999 NPI number — DR. ANTHONY N SODD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SODD
Provider First Name:
ANTHONY
Provider Middle Name:
N
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1467407999
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2153 DEPT 20002
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35287-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-465-0012
Provider Business Mailing Address Fax Number:
303-438-1351

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 GOOD SAMARITAN WAY
Provider Second Line Business Practice Location Address:
ATTN: RADIOLOGY DEPT
Provider Business Practice Location Address City Name:
MOUNT VERNON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62864-2402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-242-4600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2006

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: 2085R0202X , with the licence number:  36107586 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 300138686 . This is a "RAILROAD ST JOE & UTLAH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036107586-1 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300138685 . This is a "RAILROAD GOOD SAM & ST MARY'S" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".