Healthcare Provider Details

I. General information

NPI: 1871850297
Provider Name (Legal Business Name): NOAH TUCKER INPATIENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 04/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

987 DRAYTON STREET
ELBA AL
36323
US

IV. Provider business mailing address

815 S PALAFOX ST STE 300
PENSACOLA FL
32502-5960
US

V. Phone/Fax

Practice location:
  • Phone: 334-897-2257
  • Fax:
Mailing address:
  • Phone: 800-444-7009
  • Fax: 800-305-3233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH W TAYLOR
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 800-444-7009