Provider Demographics
NPI:1225159981
Name:NORTH EAST ALABAMA CENTER FOR INFECTIOUS DISEASE& INTERNAL MEDICINE
Entity Type:Organization
Organization Name:NORTH EAST ALABAMA CENTER FOR INFECTIOUS DISEASE& INTERNAL MEDICINE
Other - Org Name:SUNIL K JAISWAL, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:K
Authorized Official - Last Name:JAISWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-442-7594
Mailing Address - Street 1:PO BOX 1364
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35902-1364
Mailing Address - Country:US
Mailing Address - Phone:256-442-7594
Mailing Address - Fax:256-442-7594
Practice Address - Street 1:107 MAIN ST
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35961
Practice Address - Country:US
Practice Address - Phone:256-524-4788
Practice Address - Fax:256-524-4788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22810261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000094829Medicaid
AL000060252Medicaid
AL000060252Medicare ID - Type Unspecified
ALG42605Medicare UPIN
AL000060252Medicaid