1851485981 NPI number — NORTHWEST ALABAMA MENTAL HEALTH CENTER

Table of content: CHERYL BAKER FEDEL O.D. (NPI 1114215464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851485981 NPI number — NORTHWEST ALABAMA MENTAL HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST ALABAMA MENTAL HEALTH CENTER
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:
1851485981
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5980 HIGHWAY 159
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35555-5047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-932-8769
Provider Business Mailing Address Fax Number:
205-904-8709

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5980 HIGHWAY 159
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35555-5047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-932-8769
Provider Business Practice Location Address Fax Number:
205-904-8709
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NEWMAN
Authorized Official First Name:
FLOYD
Authorized Official Middle Name:
FULTON
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
205-302-9065

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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