1902169808 NPI number — DR. MATTHEW STEPHEN BURGE MD

Table of content: DR. MATTHEW STEPHEN BURGE MD (NPI 1902169808)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902169808 NPI number — DR. MATTHEW STEPHEN BURGE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURGE
Provider First Name:
MATTHEW
Provider Middle Name:
STEPHEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1902169808
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 BROWN SPRINGS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36117-7005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-747-4159
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
645 MCQUEEN SMITH RD N STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRATTVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36066-7269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-747-2999
Provider Business Practice Location Address Fax Number:
334-747-7276
Provider Enumeration Date:
06/17/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  MD.36181 , 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: 102I936812 . This is a "MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 204557 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 511-97736 . This is a "BCBS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1902169808 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: P01919417 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 8841312 . This is a "CIGNA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 511-96290 . This is a "BCBS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: Z39181 . This is a "VIVA HEALTH" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 204555 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: Z39181 . This is a "UPIN" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com