1841468238 NPI number — CENTRAL ALABAMA FOOT CARE LLC

Table of content: STEVEN L KAGEN M.D. (NPI 1235175589)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841468238 NPI number — CENTRAL ALABAMA FOOT CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL ALABAMA FOOT CARE LLC
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:
1841468238
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 780367
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TALLASSEE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36078-0004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-283-4178
Provider Business Mailing Address Fax Number:
334-283-2190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
875 FRIENDSHIP RD
Provider Second Line Business Practice Location Address:
SUITE J
Provider Business Practice Location Address City Name:
TALLASSEE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36078-1234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-283-4178
Provider Business Practice Location Address Fax Number:
334-283-2190
Provider Enumeration Date:
02/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
EADY
Authorized Official First Name:
LYNNE
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
334-283-4178

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  71 , 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: 515-12528 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 051552056 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: J027 . This is a "MEDICARE GROUP" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 529914900 . This is a "MEDICAID GROUP" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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