1689681967 NPI number — SHELBY P SANFORD MD

Table of content: SHELBY P SANFORD MD (NPI 1689681967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689681967 NPI number — SHELBY P SANFORD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANFORD
Provider First Name:
SHELBY
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1689681967
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 AFFLINK PL STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUSCALOOSA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35406-2289
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-366-9740
Provider Business Mailing Address Fax Number:
205-344-9992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1410 MCFARLAND BLVD N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUSCALOOSA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35406-2209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-345-8208
Provider Business Practice Location Address Fax Number:
205-345-8209
Provider Enumeration Date:
08/01/2006

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: 2085R0001X , with the licence number:  10900 , 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: 000008441 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051008441 . This is a "BC TUSCALOOSA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 114476 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051036886 . This is a "BC WINFIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 000036886 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051501876 . This is a "BC JASAPER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 114474 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114475 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114478 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009965020 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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