1750356721 NPI number — OB SOLUTION LLC

Table of content: (NPI 1750356721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750356721 NPI number — OB SOLUTION LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OB SOLUTION LLC
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:
6
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:
1750356721
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1855 LAKELAND DRIVE
Provider Second Line Business Mailing Address:
STE M10
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-829-4730
Provider Business Mailing Address Fax Number:
601-213-5009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1855 LAKELAND DRIVE
Provider Second Line Business Practice Location Address:
STE M10
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-829-4730
Provider Business Practice Location Address Fax Number:
601-213-5009
Provider Enumeration Date:
02/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BLANCO
Authorized Official First Name:
KATHERINE
Authorized Official Middle Name:
FELICE
Authorized Official Title or Position:
CLINIC ADMINISTRATOR
Authorized Official Telephone Number:
601-829-4730

Provider Taxonomy Codes

  • Taxonomy code: 251F00000X , with the licence number:  R805546 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 73014104 . This is a "BLUECROSS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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