1740478692 NPI number — TUMMINIA INTERNAL MEDICINE PA

Table of content: (NPI 1740478692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740478692 NPI number — TUMMINIA INTERNAL MEDICINE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TUMMINIA INTERNAL MEDICINE 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:
1740478692
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5130 LINTON BLVD
Provider Second Line Business Mailing Address:
SUITE E-2
Provider Business Mailing Address City Name:
DELRAY BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33484-6596
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-498-8031
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5130 LINTON BLVD
Provider Second Line Business Practice Location Address:
SUITE E-2
Provider Business Practice Location Address City Name:
DELRAY BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33484-6596
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-498-8891
Provider Business Practice Location Address Fax Number:
561-498-8031
Provider Enumeration Date:
10/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TUMMINIA
Authorized Official First Name:
LOUIS
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRES
Authorized Official Telephone Number:
561-498-8891

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  OS7926 , 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: 144403 . This is a "VYTRA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: K5767 . This is a "MEDICARE GROUP PIN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 46792 . This is a "BLUE CROSS BLUE SHIELD OF FLA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 110247480 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 014911000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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