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1033182241

NPI Code Detail

MEDICARE: DR. NICOLISA D MASSIE M.D.

MEDICARE: DR. NICOLISA D MASSIE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	00019447	AL
2	2088F0040X	Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician	19447	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51096368	OTHER	AL	MEDICARE
7	D815	OTHER	AL	MEDICARE GROUP PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	H17904	OTHER	AL	HEALTH SPRINGS
3	0366100001	OTHER	AL	MC NSC
4	1911001	OTHER	AL	UNITED HEALTHCARE
5	7693171	OTHER	AL	AETNA
6	3069868001	OTHER	AL	CIGNA
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	0366100001	OTHER	AL	CIGNA GOVERNMENT SERVICES PTAN
10	H17904	OTHER	AL	VIVA

General Provider Information

NPI Number	:	1033182241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLISA D MASSIE M.D.

Provider Business Mailing Address
First Line	:	3485 INDEPENDENCE DR
Second Line	:
City	:	HOMEWOOD
State	:	AL
Zip	:	35209-5603
Country	:	US
Telephone Number	:	205-930-0920
Fax Number	:	205-445-0115

Provider Business Practice Location Address
First Line	:	3485 INDEPENDENCE DR
Second Line	:
City	:	HOMEWOOD
State	:	AL
Zip	:	35209-5603
Country	:	US
Telephone Number	:	205-930-0920
Fax Number	:	205-445-0115

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	05/12/2025

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Directions to “ DR. NICOLISA D MASSIE M.D.” Practice Location

Language	Start Address	Practice Location

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