NPIMap

Organization Active NPI

Medical Spa Moksha, L.L.C.

  • Plastic Surgery Physician
  • Birmingham, AL
National Provider Identifier
1912231895
Registry record updated Sep 25, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
3370 Issued in AL
Legal business name
MEDICAL SPA MOKSHA, L.L.C.
Practice address
500 Cahaba Park Cir
Birmingham, AL 35242-5087
Phone
(205) 980-9393
Fax
(205) 980-4494
NPI assigned
Sep 25, 2009
Last updated
Sep 25, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2009

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

Authorized official

Name
Dr. William B Nickell, M.D.NPI 1306901517
Title
Medical Director
Phone
(205) 980-9393

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 3370 AL
Plastic Surgery Physician 208200000X 3370 AL Primary

Addresses

Primary practice location

500 Cahaba Park Cir
Birmingham, AL 35242-5087

Mailing address

500 Cahaba Park Cir
Birmingham, AL 35242-5087
Phone (205) 980-9393

Other identifiers 1

IdentifierTypeStateIssuer
1306901517OtherNPI

National Provider Directory

National Provider Directory

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": "1253836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1253836800000",
    "number": "1912231895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 CAHABA PARK CIR",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352425087",
            "telephone_number": "205-980-9393",
            "fax_number": "205-980-4494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 CAHABA PARK CIR",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352425087",
            "telephone_number": "205-980-9393",
            "fax_number": "205-980-4494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL SPA MOKSHA, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-25",
        "last_updated": "2009-09-25",
        "status": "A",
        "authorized_official_last_name": "NICKELL",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "205-980-9393",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "AL",
            "license": "3370",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "AL",
            "license": "3370",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1306901517",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Sep 25, 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.