1891939633 NPI number — LADIES HEALTH BOUTIQUE, INC

Table of content: (NPI 1891939633)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891939633 NPI number — LADIES HEALTH BOUTIQUE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LADIES HEALTH BOUTIQUE, 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:
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:
1891939633
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3608 HYW 118E
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:
35504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-221-7157
Provider Business Mailing Address Fax Number:
205-822-5341

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3608 HIGHWAY 78 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JASPER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35501-8909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-221-7157
Provider Business Practice Location Address Fax Number:
205-221-7159
Provider Enumeration Date:
04/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MORGAN
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
205-979-4377

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: 009981090 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51031506 . This is a "BSBC" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com