Healthcare Provider Details

I. General information

NPI: 1801324769
Provider Name (Legal Business Name): MICHAEL TODD OWENS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 05/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CENTURY PARK S
HOOVER AL
35226-3948
US

IV. Provider business mailing address

200 CENTURY PARK S
HOOVER AL
35226-3948
US

V. Phone/Fax

Practice location:
  • Phone: 205-978-9592
  • Fax: 205-978-9592
Mailing address:
  • Phone: 205-978-9592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number1150672
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: