NPIMap

Organization Active NPI

Gastroenterology Associates West PC

Doing business as Jack L. Mauldin, MD

  • Gastroenterology Physician
  • Birmingham, AL
National Provider Identifier
1659506004
Registry record updated May 28, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
6455 Issued in AL
Legal business name
GASTROENTEROLOGY ASSOCIATES WEST PC
Doing business as
Jack L. Mauldin, MD
Practice address
833 Princeton Ave SW
Suite 200D
Birmingham, AL 35211-1323
Phone
(205) 786-5527
Fax
(205) 786-5529
NPI assigned
May 28, 2009
Last updated
May 28, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jack L. Mauldin, MD
Title
President
Phone
(205) 786-5527

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X 6455 AL Primary

Addresses

Primary practice location

833 Princeton Ave SW
Suite 200D
Birmingham, AL 35211-1323

Mailing address

833 Princeton Ave SW
Suite 200D
Birmingham, AL 35211-1323
Phone (205) 786-5527

Other identifiers 1

IdentifierTypeStateIssuer
000004027MedicaidAL

Other names 1

  • JACK L. MAULDIN, MD Doing business as

National Provider Directory

National Provider Directory

Locations

833 Princeton Ave SW
Ste 200D
Birmingham, AL 35211
Phone (205) 786-5527

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1243468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243468800000",
    "number": "1659506004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "833 PRINCETON AVE SW",
            "address_2": "SUITE 200D",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352111323",
            "telephone_number": "205-786-5527",
            "fax_number": "205-786-5529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "833 PRINCETON AVE SW",
            "address_2": "SUITE 200D",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352111323",
            "telephone_number": "205-786-5527",
            "fax_number": "205-786-5529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTROENTEROLOGY ASSOCIATES WEST PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-28",
        "last_updated": "2009-05-28",
        "status": "A",
        "authorized_official_last_name": "MAULDIN",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "205-786-5527",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "AL",
            "license": "6455",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000004027",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JACK L. MAULDIN, MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Birmingham, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.