1063721348 NPI number — EDWIN COLON, MD PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063721348 NPI number — EDWIN COLON, MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDWIN COLON, MD 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:
INVASIVE PAIN MANAGEMENT CLINIC
Provider Other Organization Name Type Code:
3
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:
1063721348
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 99
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DADE CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33526-0099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-929-3609
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36739 STATE ROAD 52
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
DADE CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33525-5101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-567-4117
Provider Business Practice Location Address Fax Number:
352-567-4122
Provider Enumeration Date:
10/04/2010

Additional Information

Authorized Official

Authorized Official Last Name:
DE LA CRUZ
Authorized Official First Name:
TARA
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING OFFICE
Authorized Official Telephone Number:
813-929-3609

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME56685 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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