1861454613 NPI number — MASH INC

Table of content: (NPI 1255387254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861454613 NPI number — MASH INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MASH INC
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:
1861454613
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 789
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALABASTER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-486-9003
Provider Business Mailing Address Fax Number:
205-486-2828

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42152 HWY 195 EAST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HALEYVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-486-9003
Provider Business Practice Location Address Fax Number:
205-486-2828
Provider Enumeration Date:
04/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ALVERSON
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
205-664-2059

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000054001 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 54001 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".