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DECATUR ENT ASSOC. P.C. NPI 1164487708


NPI Information

NPI: 1164487708
Provider Name: DECATUR ENT ASSOC., P.C.
Classification: Otolaryngology - 207YS0123X
Entity Type: Organization

Specialization: Facial Plastic Surgery

CLIA Number: 01D0676999

Address:
1218 13TH AVE SE
DECATUR, AL
ZIP 35601
Phone: (256) 355-6200
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DECATUR ENT ASSOC., P.C. is a facial plastic surgery otolaryngology in Decatur, AL. The provider is an otolaryngologist who specializes in facial plastic surgery. DECATUR ENT ASSOC., P.C. NPI is 1164487708. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1218 13TH AVE SE
DECATUR, AL
ZIP 35601-307
Phone: (256) 355-6200
Fax: (256) 355-6241

The provider's authorized official is Sage Kin Copeland .
The authorized official title is President and has the following contact phone number (256) 355-6200.

The CLIA number assigned to this NPI record is 01D0676999 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/18/2006 and was last updated on 8/22/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207YX0602XOtolaryngologyOtolaryngic AllergyNo
2207YS0123XOtolaryngologyFacial Plastic SurgeryYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1D380OTHERALABAMABCBS OF AL GROUP#
2D380MEDICARE ID-TYPE UNSPECIFIEDALABAMAMEDICARE GROUP#
3CM6320OTHERALABAMARAILROAD MEDICARE
4529001940MEDICAIDALABAMA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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