1700093598 NPI number — DR. HAYDEN LONG MD

Table of content: DR. HAYDEN LONG MD (NPI 1700093598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700093598 NPI number — DR. HAYDEN LONG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LONG
Provider First Name:
HAYDEN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1700093598
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 MEMORIAL HOSPITAL DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36608-1786
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-414-5900
Provider Business Mailing Address Fax Number:
251-281-1169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 MEMORIAL HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36608-1786
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-414-5900
Provider Business Practice Location Address Fax Number:
251-459-8479
Provider Enumeration Date:
05/17/2007

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: 2084N0400X , with the licence number:  MD.28557 , 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: 102I134694 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: MD28557 . This is a "ALABAMA CONTROLLED SUBSTANCEE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: MD28557 . This is a "ALABAMA MEDICAL LICENSE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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