1093262586 NPI number — GORDIUM MENTAL HEALTH

Table of content: MR. BILLY RAY HANKS JR. CRNA (NPI 1831256767)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093262586 NPI number — GORDIUM MENTAL HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GORDIUM MENTAL HEALTH
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:
1093262586
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4723 W ATLANTIC AVE ST 21
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELRAY BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-962-1771
Provider Business Mailing Address Fax Number:
561-209-0868

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4723 W ATLANTIC AVE ST 21
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELRAY BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-962-1771
Provider Business Practice Location Address Fax Number:
561-209-0868
Provider Enumeration Date:
09/01/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHIVDASANI
Authorized Official First Name:
ARPANA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIANS ASSISTANT
Authorized Official Telephone Number:
561-562-0674

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , 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)