1689770174 NPI number — SHELBY EAR NOSE AND THROAT

Table of content: (NPI 1689770174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689770174 NPI number — SHELBY EAR NOSE AND THROAT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHELBY EAR NOSE AND THROAT
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:
1689770174
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1228 1ST ST N STE 301
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALABASTER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35007-8702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-621-8900
Provider Business Mailing Address Fax Number:
205-621-7169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1228 1ST ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALABASTER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35007-8702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-621-8900
Provider Business Practice Location Address Fax Number:
205-621-7169
Provider Enumeration Date:
09/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GOGGINS
Authorized Official First Name:
MELANIE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE ADMINSTRATOR
Authorized Official Telephone Number:
205-621-8900

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  20146 , 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: 2512856002 . This is a "CIGNA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: F51696 . This is a "HEALTHSPRINGS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51025753 . This is a "BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51530334 . This is a "BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51008484 . This is a "BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 529902750 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1010027 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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