1750331104 NPI number — BENJAMIN BANKS FULMER MD

Table of content: BENJAMIN BANKS FULMER MD (NPI 1750331104)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750331104 NPI number — BENJAMIN BANKS FULMER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FULMER
Provider First Name:
BENJAMIN
Provider Middle Name:
BANKS
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:
1750331104
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
806 ST. VINCENT'S DRIVE POB 4
Provider Second Line Business Mailing Address:
SUITE 450
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-986-5200
Provider Business Mailing Address Fax Number:
205-986-5250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
806 ST. VINCENT'S DRIVE 4
Provider Second Line Business Practice Location Address:
SUITE 450
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-986-5200
Provider Business Practice Location Address Fax Number:
205-986-5250
Provider Enumeration Date:
05/10/2006

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: 207T00000X , with the licence number:  18579 , 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: 009942240 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: G08215 . This is a "SENIORS FIRST" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: G08215 . This is a "HEALTH SPRING" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051500940 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 374211700 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51500940 . This is a "BLUE CROSS AND BLUE SHIEL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51542406 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 000093823 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051500940 . This is a "BLUE ADVANTAGE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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