1477399632 NPI number — INDIA ABRAMS

Table of content: INDIA ABRAMS (NPI 1477399632)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477399632 NPI number — INDIA ABRAMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABRAMS
Provider First Name:
INDIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EATON
Provider Other First Name:
KANESIA
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CCMA
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1477399632
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
606 S CRAFT HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36617-3606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-501-0996
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 DOWNTOWNER LOOP W STE H163
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36609-5528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-386-2289
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/06/2024

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: 1041C0700X , with the licence number:  N5L2C9Z7 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: C6T9Q3Y5 , 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: 993717287 . This is a "MOBILE PHLEBOTOMY SERVICES" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".