Provider Demographics
NPI:1730126129
Name:NIEL C RASMUSSEN MD PC
Entity Type:Organization
Organization Name:NIEL C RASMUSSEN MD PC
Other - Org Name:HEADLAND FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NIEL
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:RASMUSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-693-3336
Mailing Address - Street 1:204 HOLMAN DR
Mailing Address - Street 2:
Mailing Address - City:HEADLAND
Mailing Address - State:AL
Mailing Address - Zip Code:36345-2307
Mailing Address - Country:US
Mailing Address - Phone:334-693-3336
Mailing Address - Fax:334-693-2553
Practice Address - Street 1:204 HOLMAN DR
Practice Address - Street 2:
Practice Address - City:HEADLAND
Practice Address - State:AL
Practice Address - Zip Code:36345-2307
Practice Address - Country:US
Practice Address - Phone:334-693-3336
Practice Address - Fax:334-693-2553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00021221207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
J071OtherMEDICARE GROUP NUMBER
=========OtherEIN