1306145529 NPI number — GOOD MEDICINE ACUPUNCTURE SERVICES, LLC

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 1306145529 NPI number — GOOD MEDICINE ACUPUNCTURE SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOOD MEDICINE ACUPUNCTURE SERVICES, LLC
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:
GOOD MEDICINE COMMUNITY ACUPUNCTURE
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:
1306145529
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7051 CYPRESS TER
Provider Second Line Business Mailing Address:
SUITE 206
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33907-8822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-826-8535
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7051 CYPRESS TER
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33907-8822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-826-8535
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LEOTTI
Authorized Official First Name:
DOMINIC
Authorized Official Middle Name:
A
Authorized Official Title or Position:
ACUPUNCTURE PHYSICIAN
Authorized Official Telephone Number:
239-826-8535

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AP2906 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 171100000X , with the licence number: AP2844 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2024 www.npivalidator.com