1053366708 NPI number — BYRAM HEALTHCARE CENTERS, INC.

Table of content: (NPI 1053366708)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053366708 NPI number — BYRAM HEALTHCARE CENTERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BYRAM HEALTHCARE CENTERS, INC.
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:
1053366708
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/22/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 277596
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-7596
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-422-5516
Provider Business Mailing Address Fax Number:
770-590-8563

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4900 CREEKSIDE DR STE M
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:
33760-4041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-540-0221
Provider Business Practice Location Address Fax Number:
727-540-0161
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BERNOCCHI
Authorized Official First Name:
PERRY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CEO & PRESIDENT
Authorized Official Telephone Number:
732-302-1600

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 148362003 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 148362002 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1508583 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 031338600 . 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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