1518029354 NPI number — MR. HISHAM A BA'ALBAKI MD

Table of content: MR. HISHAM A BA'ALBAKI MD (NPI 1518029354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518029354 NPI number — MR. HISHAM A BA'ALBAKI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BA'ALBAKI
Provider First Name:
HISHAM
Provider Middle Name:
A
Provider Name Prefix Text:
MR.
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:
1518029354
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 E DR HICKS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35630-5767
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-766-8570
Provider Business Mailing Address Fax Number:
256-766-5183

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 E DR HICKS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35630-5767
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-766-8570
Provider Business Practice Location Address Fax Number:
256-766-5183
Provider Enumeration Date:
12/15/2006

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: 207RC0000X , with the licence number:  15196 , 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: 00115631 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051083040 . This is a "BCBS AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 060037833 . This is a "PALMETTO GBA RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 51591202 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 30106466 . This is a "BCBS TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4013718 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51591403 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51519601 . This is a "HEALTHSPRING OF AL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 51591203 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 000083040 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2510156 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".




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