1629028063 NPI number — KNOX M HURST III CRNA

Table of content: KNOX M HURST III CRNA (NPI 1629028063)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629028063 NPI number — KNOX M HURST III CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HURST
Provider First Name:
KNOX
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
CRNA
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:
1629028063
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2644
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:
35202-2644
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-322-1808
Provider Business Mailing Address Fax Number:
205-322-1851

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1317 4TH AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35233-1408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-458-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/10/2006

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: 367500000X , with the licence number:  1-024083 , 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: 051519491 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51519490 . This is a "BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51519491 . This is a "BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: P00099494 . This is a "PALMETTO GBA" identifier . This identifiers is of the category "OTHER".