1558578237 NPI number — GREATER ALABAMA FAMILY FOOT CARE, LLC

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 1558578237 NPI number — GREATER ALABAMA FAMILY FOOT CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREATER ALABAMA FAMILY FOOT CARE, LLC
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:
1558578237
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1026
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANETT
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36863-1026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-863-2530
Provider Business Mailing Address Fax Number:
334-642-3669

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
469 PRICE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROANOKE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36274-2104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-863-2530
Provider Business Practice Location Address Fax Number:
334-642-3669
Provider Enumeration Date:
05/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GREEN
Authorized Official First Name:
RONA
Authorized Official Middle Name:
RENELL
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
334-863-2530

Provider Taxonomy Codes

  • Taxonomy code: 261QP1100X , with the licence number:  193 , 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: 51510661 . This is a "AL BCBS NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 193 . This is a "AL STATE LIC. NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 5407030001 . This is a "AL DEMERC NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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