1659559318 NPI number — RONALD GLENN ROSEN, MD PC

Table of content: (NPI 1659559318)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659559318 NPI number — RONALD GLENN ROSEN, MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RONALD GLENN ROSEN, MD PC
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:
1659559318
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 126
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUFAULA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36072-0126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-688-7350
Provider Business Mailing Address Fax Number:
334-688-7353

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 W WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
EUFAULA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36027-1847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-688-7350
Provider Business Practice Location Address Fax Number:
334-688-7353
Provider Enumeration Date:
02/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ROSEN
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
GLENN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
334-688-7350

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1659559318 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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