1720489370 NPI number — ANNISTON DIGESTIVE HEALTH PC

Table of content: (NPI 1720489370)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720489370 NPI number — ANNISTON DIGESTIVE HEALTH PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANNISTON DIGESTIVE HEALTH 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:
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:
1720489370
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 LEIGHTON AVE
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
ANNISTON
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36207-5700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-237-1001
Provider Business Mailing Address Fax Number:
256-237-0016

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 LEIGHTON AVE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
ANNISTON
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36207-5700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-237-1001
Provider Business Practice Location Address Fax Number:
256-237-0016
Provider Enumeration Date:
09/12/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ELOUBEIDI
Authorized Official First Name:
MOHAMAD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MD/OWNER
Authorized Official Telephone Number:
256-237-1001

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  23315 , 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: 165429 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 511-53806 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com