1518100619 NPI number — ALABAMA KIDNEY ASSOCIATES INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518100619 NPI number — ALABAMA KIDNEY ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALABAMA KIDNEY ASSOCIATES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1518100619
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 361722
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35236-1722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-423-0020
Provider Business Mailing Address Fax Number:
205-423-2498

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5313 BROOKWOOD BLVD
Provider Second Line Business Practice Location Address:
STE 310
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35209-6862
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-423-0020
Provider Business Practice Location Address Fax Number:
205-423-2498
Provider Enumeration Date:
04/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
KAPOOR
Authorized Official First Name:
BHARAT
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
205-423-0020

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  08972 , 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: 08972 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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