Healthcare Provider Details

I. General information

NPI: 1225159981
Provider Name (Legal Business Name): NORTH EAST ALABAMA CENTER FOR INFECTIOUS DISEASE& INTERNAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 12/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 MAIN ST
COLLINSVILLE AL
35961
US

IV. Provider business mailing address

PO BOX 1364
GADSDEN AL
35902-1364
US

V. Phone/Fax

Practice location:
  • Phone: 256-524-4788
  • Fax: 256-524-4788
Mailing address:
  • Phone: 256-442-7594
  • Fax: 256-442-7594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number22810
License Number StateAL

VIII. Authorized Official

Name: DR. SUNIL K JAISWAL
Title or Position: CEO
Credential: MD
Phone: 256-442-7594