Basic Information
| Provider Information | |||||||||
| NPI: | 1609816685 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TEPLICK | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2867 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366522867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516908894 | ||||||||
| FaxNumber: | 2515442188 | ||||||||
| Practice Location | |||||||||
| Address1: | 251 N BAYOU ST | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366035827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516908158 | ||||||||
| FaxNumber: | 2515442188 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 11/30/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LC0200X | 24364 | AL | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 051507635 | 05 | AL | MEDICAID | 51507635 | 01 | AL | BCBS | OTHER | 011846 | 01 | AL | MEDICARE SITE GROUP NUMBER | OTHER | 1063439065 | 01 | AL | NPI SITE GROUP PAYEE NUMBER | OTHER | 20-00349 | 01 | AL | UNITED HEALTHCARE | OTHER | 630000013 | 05 | AL | MEDICAID | 009981475 | 05 | AL | MEDICAID | 271504000 | 05 | FL | MEDICAID | 51507639 | 01 | AL | BCBS | OTHER | 00125488 | 05 | MS | MEDICAID |