1912935917 NPI number — DR. JAMES RANDY BENTLEY

Table of content: DR. JAMES RANDY BENTLEY (NPI 1912935917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912935917 NPI number — DR. JAMES RANDY BENTLEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENTLEY
Provider First Name:
JAMES
Provider Middle Name:
RANDY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
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:
1912935917
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 MOBILE INFIRMARY CIR
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36607-3514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-435-7900
Provider Business Mailing Address Fax Number:
251-435-6261

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 MOBILE INFIRMARY CIR
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36607-3514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-435-7900
Provider Business Practice Location Address Fax Number:
251-435-6261
Provider Enumeration Date:
06/29/2006

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: 174400000X , with the licence number:  9721 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 9721 , 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: 51009597 . This is a "MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 05525700001 . This is a "CIGNA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51009597 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 528902340 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com