1245531490 NPI number — H V IYER MD PA

Table of content: (NPI 1245531490)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245531490 NPI number — H V IYER MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
H V IYER 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:
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:
1245531490
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3089
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOMOSASSA SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34447-3089
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-628-7672
Provider Business Mailing Address Fax Number:
352-628-5190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3475 S SUNCOAST BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOMOSASSA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34448-2322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-628-7672
Provider Business Practice Location Address Fax Number:
352-628-5190
Provider Enumeration Date:
11/04/2010

Additional Information

Authorized Official

Authorized Official Last Name:
IYER
Authorized Official First Name:
HARI
Authorized Official Middle Name:
V
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
352-628-7672

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  ME0044371 , 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: 048855100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09070 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 09070 . This is a "BLUE SHIELD HEALTH OPTION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 110023029 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 217649 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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