1093782575 NPI number — ANUBHA JATI M.D.

Table of content: ANUBHA JATI M.D. (NPI 1093782575)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093782575 NPI number — ANUBHA JATI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JATI
Provider First Name:
ANUBHA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1093782575
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16036 THORN WOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33908-4133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-641-5000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 UNIVERSITY PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AIKEN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29801-6302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-641-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/03/2006

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: 2084N0400X , with the licence number:  40164 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084N0400X , with the licence number: MD.15268R , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 204D00000X , with the licence number: 15268R , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: ME121356 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 015253500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: PENDING , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01457513 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1196096 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 112973900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".