1184883191 NPI number — ASHRAF M HASSAN

Table of content: ASHRAF M HASSAN (NPI 1184883191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184883191 NPI number — ASHRAF M HASSAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HASSAN
Provider First Name:
ASHRAF
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

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:
1184883191
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1652 BRAGG DR
Provider Second Line Business Mailing Address:
#302N
Provider Business Mailing Address City Name:
CELEBRATION
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34747-5182
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-375-7518
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 POPE AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINTER HAVEN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33881-4679
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-299-2630
Provider Business Practice Location Address Fax Number:
863-969-0711
Provider Enumeration Date:
06/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  ME118686 , 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: 1184883191 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 013927200 . 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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