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General NPI Number Information
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NPI Number | 1225159981
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Entity Type | Organization
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Legal Business Name | NORTH EAST ALABAMA CENTER FOR INFECTIOUS DISEASE& INTERNAL MEDICINE
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 12/06/2010
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Provider Practice Location Address
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Address Line | 107 MAIN ST
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City | COLLINSVILLE
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State | AL
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Zip | 35961
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Country | US
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Telephone | 256-524-4788
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Fax | 256-524-4788
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Provider Business Mailing Address
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Address Line | PO BOX 1364
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City | GADSDEN
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State | AL
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Zip | 35902-1364
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Country | US
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Telephone | 256-442-7594
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Fax | 256-442-7594
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Authorized Official
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Title or Position | CEO
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Name | DR. SUNIL K JAISWAL
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Credential | MD
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Telephone | 256-442-7594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 22810
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License Number State | AL
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