1477911949 NPI number — MR. RICHARD EUGENE GISH JR. B.S.

Table of content: MR. RICHARD EUGENE GISH JR. B.S. (NPI 1477911949)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477911949 NPI number — MR. RICHARD EUGENE GISH JR. B.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GISH
Provider First Name:
RICHARD
Provider Middle Name:
EUGENE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
B.S.
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:
1477911949
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
UAB COMMUNITY PSYCHIATRY
Provider Second Line Business Mailing Address:
908 20TH STREET SOUTH RM 487
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35294-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-934-9715
Provider Business Mailing Address Fax Number:
205-975-8950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UAB COMMUNITY PSYCHIATRY
Provider Second Line Business Practice Location Address:
908 20TH STREET SOUTH RM 487
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35294-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-934-9715
Provider Business Practice Location Address Fax Number:
205-975-8950
Provider Enumeration Date:
01/29/2016

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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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