Provider Demographics
NPI:1346490604
Name:FEAGIN & OWEN, M.D.., P.C.
Entity Type:Organization
Organization Name:FEAGIN & OWEN, M.D.., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:C
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-793-7211
Mailing Address - Street 1:4300 W MAIN ST
Mailing Address - Street 2:SUITE 43
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-1054
Mailing Address - Country:US
Mailing Address - Phone:334-793-7211
Mailing Address - Fax:334-793-5425
Practice Address - Street 1:4300 W MAIN ST
Practice Address - Street 2:SUITE 43
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1054
Practice Address - Country:US
Practice Address - Phone:334-793-7211
Practice Address - Fax:334-793-5425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7921261QM2500X
AL13944261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000011782Medicaid
AL000082133Medicaid
AL1427141282OtherINDIVIDUAL NPI FOR DR. CHARLES FEAGIN
AL1619062064OtherINDIVIDUAL NPI FOR DR. WILLIAM I. OWEN
AL11782OtherBCBS OF ALABAMA PROVIDER NUMBER -- CHARLES FEAGIN, M.D.
AL82133OtherBCBS OF ALABAMA PROVIDER FOR DR. WILLIAM I. OWEN, JR
AL529001560OtherALABAMA MEDICAID PAYEE ID: 529001560
AL1619062064OtherINDIVIDUAL NPI FOR DR. WILLIAM I. OWEN
AL000011782Medicare PIN
ALC75671Medicare UPIN
ALE42073Medicare UPIN