|Provider Name||EDNECIA FITZPATRICK|
|Provider Location Address||6107 BROADWING RD TRUSSVILLE, AL 35173|
|Provider Mailing Address||6107 BROADWING RD TRUSSVILLE, AL 35173|
|NPI Entity Type||Individual|
|Is Sole Proprietor?||Yes|
|Is Organization Subpart?||N/A|
|Last Update Date||11-17-2020|
6107 BROADWING RD
Phone: (404) 442-5001
6107 BROADWING RD
The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.
|No.||Taxonomy Code||Type||Classification||Specialization||License No.||State||Primary|
|1||172A00000X||Other Service Providers||Driver||No|
Taxonomy Description: a person employed to operate a motor vehicle as a carrier of persons or property.
Taxonomy Description: a public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.
|3||261QM0801X||Ambulatory Health Care Facilities||Clinic/Center||Mental Health (Including Community Mental Health Center)||No|
Taxonomy Description: Not Available
|4||343900000X||Transportation Services||Non-emergency Medical Transport (VAN)||No|
Taxonomy Description: a land vehicle with a capacity to meet special height, clearance, access, and seating, for the conveyance of persons in non-emergency situations. The vehicle may or may not be required to meet local county or state regulations.
|5||376G00000X||Nursing Service Related Providers||Nursing Home Administrator||No|
Taxonomy Description: an individual, often licensed by the state, who is responsible for the management of a nursing home.
Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
|Identifier||Type / Code||Identifier State|
What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider Location Address
The 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.
Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type 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 (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.
Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date
The date that a NPI record was last updated or changed.
Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.