1598751216 NPI number — OSTEOPATHIC HERITAGE, P.A.

Table of content: (NPI 1598751216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598751216 NPI number — OSTEOPATHIC HERITAGE, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OSTEOPATHIC HERITAGE, P.A.
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:
OSTEOPATHIC HERITAGE, CORP.
Provider Other Organization Name Type Code:
4
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:
1598751216
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
118 SEVEN HILLS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING HILL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34609-0235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-666-6950
Provider Business Mailing Address Fax Number:
352-666-6438

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
118 SEVEN HILLS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING HILL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34609-0235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-666-6950
Provider Business Practice Location Address Fax Number:
352-666-6438
Provider Enumeration Date:
09/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GROVE
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
352-666-6950

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207QA0505X , with the licence number: OS6098 , 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