1083701452 NPI number — DR. WILLIAM JAMES TINGLE MD

Table of content: DR. WILLIAM JAMES TINGLE MD (NPI 1083701452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083701452 NPI number — DR. WILLIAM JAMES TINGLE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TINGLE
Provider First Name:
WILLIAM
Provider Middle Name:
JAMES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1083701452
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 198054
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:
30384-8054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-662-7980
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3303 OVERSEAS HWY STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARATHON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33050-2329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-662-5610
Provider Business Practice Location Address Fax Number:
786-533-9980
Provider Enumeration Date:
10/06/2006

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: 208800000X , with the licence number:  ME59349 , 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: 376030800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1484132 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1193488 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 208525 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P01807653 . This is a "CLEAR HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P104324 . This is a "FREEDOM HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 340009780 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: P01078296 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: QMP000005228656 . This is a "MOLINA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 165719 . This is a "UNIVERSAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P512083 . This is a "OPTIMUM" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4605729 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 376030800 . 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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