1275515850 NPI number — FC OF ALABAMA INC

Table of content: (NPI 1275515850)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275515850 NPI number — FC OF ALABAMA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FC OF ALABAMA 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:
INTREPID USA HEALTHCARE SERVICES
Provider Other Organization Name Type Code:
3
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:
1275515850
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3220 KELLER SPRINGS RD STE 108
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARROLLTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75006-5911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-445-3750
Provider Business Mailing Address Fax Number:
214-445-3900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
445 DEXTER AVE STE 4050
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36104-3867
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-270-7913
Provider Business Practice Location Address Fax Number:
334-270-0668
Provider Enumeration Date:
11/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MCMULLEN
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
M
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
214-445-3750

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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