1689942302 NPI number — ADLER PODIATRY CLINIC PLLC

Table of content: (NPI 1689942302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689942302 NPI number — ADLER PODIATRY CLINIC PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADLER PODIATRY CLINIC PLLC
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:
1689942302
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3636 UNIVERSITY BLVD S
Provider Second Line Business Mailing Address:
BLDG C
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32216-4250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-731-1711
Provider Business Mailing Address Fax Number:
904-731-9270

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3636 UNIVERSITY BLVD S
Provider Second Line Business Practice Location Address:
BLDG C
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32216-4250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-731-1711
Provider Business Practice Location Address Fax Number:
904-731-9270
Provider Enumeration Date:
12/08/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GUENTHER
Authorized Official First Name:
CARRIE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
904-731-1711

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 002RX . This is a "BCBSFL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: DS3051 . This is a "RR MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".