1801830815 NPI number — DR. SAMUEL W BEENKEN MD

Table of content: DR. SAMUEL W BEENKEN MD (NPI 1801830815)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801830815 NPI number — DR. SAMUEL W BEENKEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEENKEN
Provider First Name:
SAMUEL
Provider Middle Name:
W
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:
1801830815
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
176 BONNIEVILLE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CALERA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35040-3606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-478-7575
Provider Business Mailing Address Fax Number:
855-450-0848

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5510 HIGHWAY 280
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35242-6582
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-624-4325
Provider Business Practice Location Address Fax Number:
205-620-6776
Provider Enumeration Date:
06/16/2006

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: 208D00000X , with the licence number:  15438 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X , with the licence number: PM.552 , 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: 020016114 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 000082627 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 000082627 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: E50317 . This is a "VIVA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com