1801977012 NPI number — LISA EICH DMD

Table of content: LISA EICH DMD (NPI 1801977012)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801977012 NPI number — LISA EICH DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EICH
Provider First Name:
LISA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD
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:
1801977012
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2201 ARLINGTON AVE
Provider Second Line Business Mailing Address:
JEFFERSON COUNTY HEALTH DEPT-BESSEMER DENTAL CLINIC
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-930-1422
Provider Business Mailing Address Fax Number:
205-930-1448

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2201 ARLINGTON AVE
Provider Second Line Business Practice Location Address:
JEFFERSON COUNTY HEALTH DEPT-BESSEMER DENTAL CLINIC
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-930-1422
Provider Business Practice Location Address Fax Number:
205-930-1448
Provider Enumeration Date:
10/17/2006

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: 1223G0001X , with the licence number:  4488 , 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: 009934365 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51513228EIC . This is a "BLUE CROSS#-CENTRAL DENTA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009934375 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009934385 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51513230 . This is a "BLUE CROSS BLUE SHIELD WESTERN DENTAL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51548198 . This is a "BLUE CROSS BLUE SHIELD EASTERN DENTAL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51513229EIC . This is a "BLUE CROSS#-BESSEMER DENT" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009934355 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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