1760430425 NPI number — MRS. KRISTY J MAGEE M.D.

Table of content: MRS. KRISTY J MAGEE M.D. (NPI 1760430425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760430425 NPI number — MRS. KRISTY J MAGEE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAGEE
Provider First Name:
KRISTY
Provider Middle Name:
J
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1760430425
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5300 SR 46 STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANFORD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32771-9333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-688-4251
Provider Business Mailing Address Fax Number:
407-322-2507

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5300 SR 46 STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANFORD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32771-9333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-688-4251
Provider Business Practice Location Address Fax Number:
407-322-2507
Provider Enumeration Date:
05/05/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  ME88578 , 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: 7054656 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 562499046 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7712437 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 18132 . This is a "FHHS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 297960 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 64363 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 110005800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".