1790987725 NPI number — RIVER CITY ALLERGY & MEDICAL PA

Table of content: (NPI 1790987725)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790987725 NPI number — RIVER CITY ALLERGY & MEDICAL PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVER CITY ALLERGY & MEDICAL PA
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:
1790987725
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 S MAIN ST STE 1300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38103-5513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-949-0108
Provider Business Mailing Address Fax Number:
256-547-9755

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 20TH ST N STE 2200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35203-3261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-949-0108
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/01/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
256-547-4971

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000740 . This is a "PTAN" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 040015339 . This is a "RAILROAD RETIREMENT MEDIC" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 051000740 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".