1669481222 NPI number — PERFORMANCE GROUP ALBERTVILLE

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 1669481222 NPI number — PERFORMANCE GROUP ALBERTVILLE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERFORMANCE GROUP ALBERTVILLE
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:
1669481222
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 14149
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70898-4149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-924-9827
Provider Business Mailing Address Fax Number:
225-924-9829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4198 U.S. HWY. 431
Provider Second Line Business Practice Location Address:
STE D
Provider Business Practice Location Address City Name:
ALBERTVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35951-0238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-894-3870
Provider Business Practice Location Address Fax Number:
256-894-3872
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
ANDREW
Authorized Official Title or Position:
BILLING COORDINATOR
Authorized Official Telephone Number:
256-744-3350

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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