1124276167 NPI number — CENTER FOR HEALTH OF CHARLOTTE 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 1124276167 NPI number — CENTER FOR HEALTH OF CHARLOTTE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR HEALTH OF CHARLOTTE 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:
1124276167
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1107 W MARION AVE
Provider Second Line Business Mailing Address:
116
Provider Business Mailing Address City Name:
PUNTA GORDA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33950-5372
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-637-7000
Provider Business Mailing Address Fax Number:
941-639-7576

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1107 W MARION AVE
Provider Second Line Business Practice Location Address:
116
Provider Business Practice Location Address City Name:
PUNTA GORDA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33950-5372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-637-7000
Provider Business Practice Location Address Fax Number:
941-639-7576
Provider Enumeration Date:
09/03/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RUGGIERI
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
941-637-7000

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  ME0055973 , 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)

  • Identifier: 97988 . This is a "BCBS FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".