1801904982 NPI number — MARY C GIPSON MD

Table of content: MARY C GIPSON MD (NPI 1801904982)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801904982 NPI number — MARY C GIPSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIPSON
Provider First Name:
MARY
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1801904982
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
118 MARS HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOOVER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35244-3904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-502-5801
Provider Business Mailing Address Fax Number:
205-502-5586

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
118 MARS HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOOVER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35244-3904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-987-0005
Provider Business Practice Location Address Fax Number:
205-987-0065
Provider Enumeration Date:
08/28/2006

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: 207Q00000X , with the licence number:  15324 , 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: 051082416 . This is a "BCBS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 510-05037 . This is a "BC BS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 000082416 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009910908 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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