1477885606 NPI number — LLPI HEALTHCARE ADVOCATES

Table of content: (NPI 1477885606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477885606 NPI number — LLPI HEALTHCARE ADVOCATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LLPI HEALTHCARE ADVOCATES
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:
1477885606
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3028 ATHERLEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT AUGUSTINE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32092-5052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
904-217-3170

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3028 ATHERLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT AUGUSTINE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32092-5052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-994-3226
Provider Business Practice Location Address Fax Number:
904-217-3170
Provider Enumeration Date:
02/15/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ILARIA
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
904-540-5709

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X , with the licence number:  F09000000292 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251K00000X , with the licence number: 3659481 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 302F00000X , with the licence number: F09000000292 , 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: SARJOSH2 . This is a "ALL INSURANCE PAYEES" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: SARJOSH2 . This is a "INSURANCE PROVIDERS DISCOUNT MARKET" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: SARJOSH2 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".