1629281472 NPI number — THOMAS J SULTENFUSS MD PA

Table of content: (NPI 1629281472)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629281472 NPI number — THOMAS J SULTENFUSS MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS J SULTENFUSS MD PA
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:
1629281472
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1022 MAIN ST STE R
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUNEDIN
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34698-5225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-734-6710
Provider Business Mailing Address Fax Number:
727-734-6712

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1022 MAIN ST STE R
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNEDIN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34698-5225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-734-6710
Provider Business Practice Location Address Fax Number:
727-734-6712
Provider Enumeration Date:
05/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SULTENFUSS
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
JOESPH
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
727-734-6710

Provider Taxonomy Codes

  • Taxonomy code: 207NS0135X , with the licence number:  ME34798 , 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: 0965599 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4235833 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1000091 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 62317 . This is a "BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: CL2114 . This is a "PALMETTO GBA MEDICARE RR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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