1215086111 NPI number — DR. MARILYN JOY HEPPERLE M.D, FRCP

Table of content: DR. MARILYN JOY HEPPERLE M.D, FRCP (NPI 1215086111)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215086111 NPI number — DR. MARILYN JOY HEPPERLE M.D, FRCP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEPPERLE
Provider First Name:
MARILYN
Provider Middle Name:
JOY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D, FRCP
Provider Gender Code:
F

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:
1215086111
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
645 MCQUEEN SMITH RD N
Provider Second Line Business Mailing Address:
SUIT 302
Provider Business Mailing Address City Name:
PRATTVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36066-7268
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-361-7404
Provider Business Mailing Address Fax Number:
334-361-7863

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
645 MCQUEEN SMITH RD N
Provider Second Line Business Practice Location Address:
SUIT 302
Provider Business Practice Location Address City Name:
PRATTVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36066-7268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-361-7404
Provider Business Practice Location Address Fax Number:
334-361-7863
Provider Enumeration Date:
01/09/2007

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:  20750 , 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: 582326526 . This is a "TAX ID" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051038657HEP . This is a "BLUE CROSSBLUESHEILD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 110155714 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: HE000038657 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000038657 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4-10195 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".




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