1467431890 NPI number — ROBERT C. HAYES OD

Table of content: ROBERT C. HAYES OD (NPI 1467431890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467431890 NPI number — ROBERT C. HAYES OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAYES
Provider First Name:
ROBERT
Provider Middle Name:
C.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1467431890
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 376
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHELSEA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35043-0376
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-678-2020
Provider Business Mailing Address Fax Number:
205-678-2021

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16233 HIGHWAY 280
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
CHELSEA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35043-8301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-678-2020
Provider Business Practice Location Address Fax Number:
205-678-2021
Provider Enumeration Date:
01/13/2006

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: 152W00000X , with the licence number:  S-683-TA-175 , 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: 2210080 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: OT41014 . This is a "MEDICARE COMPLETE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 924628 . This is a "BLOCK VISION PROVIDER NUM" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1019620001 . This is a "PALMETTO GOVERNMENT" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 58430 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 00058430 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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