1821491895 NPI number — OCALA MEDICAL AND INFECTIOUS DISEASE ASSOCIATES PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821491895 NPI number — OCALA MEDICAL AND INFECTIOUS DISEASE ASSOCIATES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OCALA MEDICAL AND INFECTIOUS DISEASE ASSOCIATES 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:
1821491895
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3306 SW 26TH AVE
Provider Second Line Business Mailing Address:
STE 104
Provider Business Mailing Address City Name:
OCALA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34471-7856
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-622-2020
Provider Business Mailing Address Fax Number:
352-622-2025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3306 SW 26TH AVE
Provider Second Line Business Practice Location Address:
STE 104
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34471-7856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-622-2020
Provider Business Practice Location Address Fax Number:
352-622-2025
Provider Enumeration Date:
10/03/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SOOSAIPILLAI
Authorized Official First Name:
IVAN
Authorized Official Middle Name:
I
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
352-622-2020

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 013502700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008N8 . This is a "BCBS OF FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com