1811166333 NPI number — CENTRAL ALABAMA WOMEN'S CLINIC

Table of content: (NPI 1811166333)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811166333 NPI number — CENTRAL ALABAMA WOMEN'S CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL ALABAMA WOMEN'S CLINIC
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:
DR. SAMUEL C LETT
Provider Other Organization Name Type Code:
4
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:
1811166333
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1013 MEDICAL CENTER PKWY
Provider Second Line Business Mailing Address:
BLD 1 SUITE 103
Provider Business Mailing Address City Name:
SELMA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36701-6742
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-875-1440
Provider Business Mailing Address Fax Number:
334-875-1446

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1013 MEDICAL CENTER PKWY
Provider Second Line Business Practice Location Address:
BLD 1 SUITE 103
Provider Business Practice Location Address City Name:
SELMA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36701-6742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-875-1440
Provider Business Practice Location Address Fax Number:
334-875-1446
Provider Enumeration Date:
02/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LETT
Authorized Official First Name:
SAMUEL
Authorized Official Middle Name:
C
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
334-875-1440

Provider Taxonomy Codes

  • Taxonomy code: 261QA0006X , with the licence number:  AL8853865 , 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: C74876 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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