1578863031 NPI number — 1272 STIRLING MEDICAL GROUP, LLC

Table of content: (NPI 1578863031)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578863031 NPI number — 1272 STIRLING MEDICAL GROUP, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
1272 STIRLING MEDICAL GROUP, 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:
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:
1578863031
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7240
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JUPITER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33468-7240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-748-2889
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1272 LONG HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STIRLING
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07980-1010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-748-2889
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/29/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BARLOW
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING COMPANY
Authorized Official Telephone Number:
561-748-2889

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  26NN11834600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com