1932376233 NPI number — SYMPHONY DIAGNOSTIC SERVICES NO 1 LLC

Table of content: (NPI 1932376233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932376233 NPI number — SYMPHONY DIAGNOSTIC SERVICES NO 1 LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SYMPHONY DIAGNOSTIC SERVICES NO 1 LLC
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:
TRIDENTCARE
Provider Other Organization Name Type Code:
3
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:
1932376233
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
930 RIDGEBROOK RD FL 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPARKS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21152-9481
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-786-8015
Provider Business Mailing Address Fax Number:
443-662-4230

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4400 140TH AVE N STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARWATER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33762-3813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-786-8015
Provider Business Practice Location Address Fax Number:
443-842-7264
Provider Enumeration Date:
05/15/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CUOMO
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
AUTHORIZED OFFICIAL/CFO
Authorized Official Telephone Number:
800-786-8015

Provider Taxonomy Codes

  • Taxonomy code: 293D00000X , with the licence number:  3008665 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8105030 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110029440B , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0014859080025 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004222098 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2396978 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 92623514 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9419801 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 086063702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42507500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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