=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548710197
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INFIRMARY HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2016
-----------------------------------------------------
Last Update Date | 10/06/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 MOBILE INFIRMARY CIR
-----------------------------------------------------
City | MOBILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36607-3513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-435-5822
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2226
-----------------------------------------------------
City | MOBILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36652-2226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CRNP
-----------------------------------------------------
Name | ZAKIYYAH JONES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 251-472-7796
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282E00000X
-----------------------------------------------------
Taxonomy Name | Long Term Care Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------