MEDICARE: NIEL C RASMUSSEN MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	00021221	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	J071	OTHER		MEDICARE GROUP NUMBER

General Provider Information

NPI Number	:	1730126129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NIEL C RASMUSSEN MD PC

Provider Business Mailing Address
First Line	:	204 HOLMAN DR
Second Line	:
City	:	HEADLAND
State	:	AL
Zip	:	36345-2307
Country	:	US
Telephone Number	:	334-693-3336
Fax Number	:	334-693-2553

Provider Business Practice Location Address
First Line	:	204 HOLMAN DR
Second Line	:
City	:	HEADLAND
State	:	AL
Zip	:	36345-2307
Country	:	US
Telephone Number	:	334-693-3336
Fax Number	:	334-693-2553

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. NIEL CHRISTIAN RASMUSSEN
Credential	:	MD
Telephone Number	:	334-693-3336

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	08/22/2020

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