1043292972 NPI number — NEUROLOGICAL SERVICES OF ORLANDO PA

Table of content: (NPI 1043292972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043292972 NPI number — NEUROLOGICAL SERVICES OF ORLANDO PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUROLOGICAL SERVICES OF ORLANDO PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043292972
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 568305
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32856-8305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-240-1762
Provider Business Mailing Address Fax Number:
407-812-5869

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3849 OAKWATER CIRCLE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32806-6264
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-240-1762
Provider Business Practice Location Address Fax Number:
407-812-5869
Provider Enumeration Date:
11/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
AMARO
Authorized Official First Name:
JAIME
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
407-240-1762

Provider Taxonomy Codes

  • Taxonomy code: 204D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 38645 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 016782200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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