1326195173 NPI number — RANDALL LEE NORD PA

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326195173 NPI number — RANDALL LEE NORD PA

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

NORD

Provider First Name:

RANDALL

Provider Middle Name:

LEE

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

PA

Provider Gender Code:

M

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:

1326195173

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

09/17/2024

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1004 1ST ST N STE 390

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

ALABASTER

Provider Business Mailing Address State Name:

AL

Provider Business Mailing Address Postal Code:

35007-8616

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

205-620-7523

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

1004 1ST ST N STE 390

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

ALABASTER

Provider Business Practice Location Address State Name:

AL

Provider Business Practice Location Address Postal Code:

35007-8616

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

205-620-7523

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

01/04/2007

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 363AS0400X , with the licence number:  5387 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 363AS0400X , with the licence number: 2023025752 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 363AS0400X , with the licence number: PA.763 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 133039 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 051120557 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 051120559 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 133030 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 133034 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 970024545 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 051120556 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 06021281 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
• Identifier: 7901940 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
• Identifier: S17209 . This is a "VIVA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".