1639214588 NPI number — PROXSYS RX - ALABAMA LLC

Table of content: (NPI 1639214588)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639214588 NPI number — PROXSYS RX - ALABAMA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROXSYS RX - ALABAMA 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:
6
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:
1639214588
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 URBAN CENTER DR STE 325
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VESTAVIA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35242-2205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-533-9119
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 10TH AVE S
Provider Second Line Business Practice Location Address:
STE 106
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35205-1200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-930-2520
Provider Business Practice Location Address Fax Number:
205-930-2522
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CALHOUN
Authorized Official First Name:
BILLY
Authorized Official Middle Name:
RAY
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
205-533-9119

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 108792 , 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: 2163819 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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