1487054235 NPI number — MR. CHRISTOPHER B IRELAND DPT

Table of content: MR. CHRISTOPHER B IRELAND DPT (NPI 1487054235)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487054235 NPI number — MR. CHRISTOPHER B IRELAND DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IRELAND
Provider First Name:
CHRISTOPHER
Provider Middle Name:
B
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
DPT
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:
1487054235
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
80 TECHNACENTER DR
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36117-6028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-625-5795
Provider Business Mailing Address Fax Number:
334-396-4905

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7061 HALCYON SUMMIT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36117-6927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-396-2110
Provider Business Practice Location Address Fax Number:
334-396-2115
Provider Enumeration Date:
08/29/2014

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: 225100000X , with the licence number:  PT24785 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: PTH7315 , 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: 13765705 . This is a "CAQH" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 511-54880 . This is a "BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 511-54877 . This is a "BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 511-54879 . This is a "BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: P01586196 . This is a "MEDICARE RR" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 511-54878 . This is a "BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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