1790875763 NPI number — AMERICAN SPORTS MEDICINE INSTITUTE

Table of content: (NPI 1790875763)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790875763 NPI number — AMERICAN SPORTS MEDICINE INSTITUTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN SPORTS MEDICINE INSTITUTE
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:
1790875763
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2660 10TH AVE S
Provider Second Line Business Mailing Address:
SUITE 505
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35205-1605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-918-0000
Provider Business Mailing Address Fax Number:
205-918-2177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2660 10TH AVE S
Provider Second Line Business Practice Location Address:
SUITE 505
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35205-1605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-918-0000
Provider Business Practice Location Address Fax Number:
205-918-2177
Provider Enumeration Date:
10/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCWHORTER
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF ADMINISTRATION
Authorized Official Telephone Number:
205-918-2135

Provider Taxonomy Codes

  • Taxonomy code: 261QR1100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 515-25052 . This is a "BCBS AL PROVIDER NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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