1083701452 NPI number — DR. WILLIAM JAMES TINGLE MD

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

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 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:

1083701452

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/20/2024

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

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 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

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• 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" .

• 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".