1730776220 NPI number — TRADITIONS HEALTH CARE OF EUFAULA, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730776220 NPI number — TRADITIONS HEALTH CARE OF EUFAULA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRADITIONS HEALTH CARE OF EUFAULA, LLC
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:
TRADITIONS HEALTH OF EUFAULA
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:
1730776220
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6840 CAROTHERS PKWY STE 550
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37067-8002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
979-704-6547
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 S MAIN ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUFAULA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74432-3222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-618-4248
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/30/2020

Additional Information

Authorized Official

Authorized Official Last Name:
KERNDL
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
979-704-6547

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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