NPI Record of DOCTORS MED CARE OF JACKSONVILLE, P.C. NPI 1326079922

Family Medicine in Jacksonville, AL

Complete NPI Record

Field Name Value Definition
NPI1326079922The 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.
Entity Type Code2Code 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).
Employer Identification Number EINUNAVAILThe Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Organization Name Legal Business NameDOCTORS MED CARE OF JACKSONVILLE, P.C.The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address1505 PELHAM RD SThe first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Second Line Business Mailing AddressSTE 2The second line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider second line location address’’.
Provider Business Mailing Address City NameJACKSONVILLEThe city name in the mailing address of the provider being identified.
Provider Business Mailing Address State NameALThe State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code362653706The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S USThe country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number2564357300The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number2564357305The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address1505 PELHAM RD SThe 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.
Provider Second Line Business Practice Location AddressSTE 2The 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.
Provider Business Practice Location Address City NameJACKSONVILLEThe city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameALThe State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code362653706The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S USThe country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number2564357300The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number2564357305The fax number associated with the location address of the provider being identified.
Provider Enumeration Date7/5/2006The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date8/22/2020The date that a record was last updated or changed.
Authorized Official Last NameTAHERThe last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameAKILThe first name of the authorized official.
Authorized Official Title or PositionSECRETARYThe title or position of the authorized official.
Authorized Official Telephone Number2564357300The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1207Q00000XCode 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.
Healthcare Provider Primary Taxonomy Switch 1Y
Is Organization SubpartN
Authorized Official Name Prefix TextDR.
Healthcare Provider Taxonomy Group 1193200000X MULTI-SPECIALTY GROUP