1083616437 NPI number — MOFFITT HEART AND VASCULAR GROUP INC.

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 1083616437 NPI number — MOFFITT HEART AND VASCULAR GROUP INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOFFITT HEART AND VASCULAR GROUP 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:
1083616437
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 N FRONT ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
WORMLEYSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17043-1034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-731-0101
Provider Business Mailing Address Fax Number:
717-441-0592

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 N FRONT ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
WORMLEYSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17043-1034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-731-0101
Provider Business Practice Location Address Fax Number:
717-441-0592
Provider Enumeration Date:
08/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
STROUSE
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
717-731-0101

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , 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)





Copyright © 2007-2025 www.npivalidator.com