1861478133 NPI number — MED-SOUTH, INC.

Table of content: (NPI 1861478133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861478133 NPI number — MED-SOUTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MED-SOUTH, 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:
1861478133
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
406 MEDICAL CENTER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JASPER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35501-3400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-221-8200
Provider Business Mailing Address Fax Number:
205-221-8270

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1029 W FORT WILLIAMS ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SYLACAUGA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35150-2301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-245-3007
Provider Business Practice Location Address Fax Number:
256-245-3068
Provider Enumeration Date:
12/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PACE
Authorized Official First Name:
STEWART
Authorized Official Middle Name:
H
Authorized Official Title or Position:
SR VICE PRESIDENT OF CORPORATE DEVL
Authorized Official Telephone Number:
205-414-7525

Provider Taxonomy Codes

  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 900125 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 181 , 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: 009610960 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com