DOTHAN ANESTHESIOLOGY ASSOCIATES PC - NPI NUMBER 1013997857

Summary

Provider Name: DOTHAN ANESTHESIOLOGY ASSOCIATES PC

NPI Number: 1013997857

Clasification: Anesthesiology (207LP2900X)

Specialization: Pain Medicine

Address:
4370 W MAIN ST
ANESTHESIA DEPT
DOTHAN, AL
ZIP 36305

Phone Number: (334) 794-5000



Detailed Information

DOTHAN ANESTHESIOLOGY ASSOCIATES PC is a pain medicine anesthesiologist in Dothan, AL. The provider is an anesthesiologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic and/or cancer pain in both hospital and ambulatory settings. Patient care needs are also coordinated with other specialists. The assigned NPI number for this provider is 1013997857 and is registered as an organization entity type and is a multi-specialty group.

The provider's business address is:

4370 W MAIN ST
ANESTHESIA DEPT
DOTHAN, AL
ZIP 36305-056
Phone: (334) 794-5000

The provider's authorized official is Kenneth C Fletcher .
The authorized official title is President and has the following contact phone number (334) 794-5000.

The enumeration date for this NPI number is 1/18/2006 and was last updated on 4/20/2008.

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 207LP2900X Anesthesiology Pain Medicine ========= AL No
2 207L00000X Anesthesiology ========= AL Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 E85399 MEDICARE PIN AL

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1013997857 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name DOTHAN ANESTHESIOLOGY ASSOCIATES PC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider First Line Business Practice Location Address 4370 W MAIN ST The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
6 Provider Second Line Business Practice Location Address ANESTHESIA DEPT The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
7 Provider Business Practice Location Address City Name DOTHAN The city name in the location address of the provider being identified.
8 Provider Business Practice Location Address State Name AL The State code in the location of the provider being identified.
9 Provider Business Practice Location Address Postal Code 363051056 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
10 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
11 Provider Business Practice Location Address Telephone Number 3347945000 The telephone number associated with the location address of the provider being identified.
12 Provider Enumeration Date 1/18/2006 The date the provider was assigned a unique identifier (assigned an NPI).
13 Last Update Date 4/20/2008 The date that a record was last updated or changed.
14 Authorized Official Last Name FLETCHER The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
15 Authorized Official First Name KENNETH The first name of the authorized official.
16 Authorized Official Middle Name C The middle name of the authorized official.
17 Authorized Official Title or Position PRESIDENT The title or position of the authorized official.
18 Authorized Official Telephone Number 3347945000 The 10-position telephone number of the authorized official.
19 Healthcare Provider Taxonomy Code 1 207LP2900X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
20 Provider License Number 1 ========= The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
21 Provider License Number State Code 1 AL The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
22 Healthcare Provider Primary Taxonomy Switch 1 N
23 Healthcare Provider Taxonomy Code 2 207L00000X
24 Provider License Number 2 ========= The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
25 Provider License Number State Code 2 AL The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
26 Healthcare Provider Primary Taxonomy Switch 2 Y
27 Other Provider Identifier 1 E85399 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
28 Other Provider Identifier Type Code 1 08 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
29 Other Provider Identifier State 1 AL
30 Is Organization Subpart N
31 Authorized Official Credential Text MD
32 Healthcare Provider Taxonomy Group 1 193200000X MULTI-SPECIALTY GROUP
33 Healthcare Provider Taxonomy Group 2 193200000X MULTI-SPECIALTY GROUP

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This page was last updated on: 4/19/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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