Basic Information
| Provider Information | |||||||||
| NPI: | 1922001643 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ERGLE | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | KEITH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | AU.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 245 CAHABA VALLEY PKWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | PELHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 351242216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003790309 | ||||||||
| FaxNumber: | 2059425627 | ||||||||
| Practice Location | |||||||||
| Address1: | 245 CAHABA VALLEY PKWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | PELHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 351242216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003790309 | ||||||||
| FaxNumber: | 2059425627 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2005 | ||||||||
| LastUpdateDate: | 05/19/2008 | ||||||||
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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 | 231H00000X | 51486 | TX | N | Speech, Language and Hearing Service Providers | Audiologist | 231H00000X | 5652 | NC | N | Speech, Language and Hearing Service Providers | Audiologist | 231H00000X | A2835 | MS | N | Speech, Language and Hearing Service Providers | Audiologist | 231H00000X | 817A | AL | Y | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 51007364 | 01 | AL | BCBS OF ALABAMA | OTHER | 7401171 | 01 | AL | AETNA | OTHER | 631209505 | 01 | AL | TRI-CARE | OTHER | 009815580 | 05 | AL | MEDICAID |