1952321903 NPI number — DR. ARLEIGH I ANCHETA D.O.

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 1952321903 NPI number — DR. ARLEIGH I ANCHETA D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANCHETA
Provider First Name:
ARLEIGH
Provider Middle Name:
I
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

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:
1952321903
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8145 CEREBELLUM WAY
Provider Second Line Business Mailing Address:
SUITE 101 & 102
Provider Business Mailing Address City Name:
TRINITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34655-1788
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-845-4999
Provider Business Mailing Address Fax Number:
866-777-2195

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8145 CEREBELLUM WAY
Provider Second Line Business Practice Location Address:
SUITE 101 & 102
Provider Business Practice Location Address City Name:
TRINITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34655-1788
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-845-4999
Provider Business Practice Location Address Fax Number:
866-777-2195
Provider Enumeration Date:
07/20/2006

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: 207V00000X , with the licence number:  OS0007816 , 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: 138682343 . This is a "GROUP NPI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 260609255 . This is a "GROUP TAX ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 001553500 . This is a "GROUP MEDICAID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 256093300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: BC538G . This is a "GROUP MEDICARE PIN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 256093300 . 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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