1962570085 NPI number — SUSAN H EILAND MD PC

Table of content: (NPI 1962570085)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962570085 NPI number — SUSAN H EILAND MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUSAN H EILAND MD PC
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:
1962570085
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2700 10TH AVE S
Provider Second Line Business Mailing Address:
SUITE 404
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35205-1250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-933-2340
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 10TH AVE S
Provider Second Line Business Practice Location Address:
SUITE 404
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35205-1250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-933-2340
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EILAND
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
HORTON
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
205-933-2340

Provider Taxonomy Codes

  • Taxonomy code: 152WC0802X , with the licence number:  4320 , 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: 180030155 . This is a "TRAVELERS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 2588 . This is a "H.SPRINGS FOR SUSAN EILAN" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 10259 . This is a "H.SPRINGS AND S.FIRST" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51006144 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 000006144 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51150395 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51500469 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 6195340 . This is a "CIGNA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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