1417127283 NPI number — SEBRING UROLOGY CENTER

Table of content: (NPI 1417127283)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417127283 NPI number — SEBRING UROLOGY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEBRING UROLOGY CENTER
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:
ANTHONY J ARCIOLA MD LLC
Provider Other Organization Name Type Code:
5
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:
1417127283
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6801 U S 27 N SUITE C 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEBRING
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33870
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-382-0333
Provider Business Mailing Address Fax Number:
863-382-8777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6801 U S HWY 27 NORTH
Provider Second Line Business Practice Location Address:
SUITE C2
Provider Business Practice Location Address City Name:
SEBRING
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-382-0333
Provider Business Practice Location Address Fax Number:
863-382-8777
Provider Enumeration Date:
03/07/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ARCIOLA
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
863-382-0333

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  49361 , 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)