1114996402 NPI number — APM PROVIDERS, INC

Table of content: (NPI 1114996402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114996402 NPI number — APM PROVIDERS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APM PROVIDERS, 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:
1114996402
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 51582
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32240-1582
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-241-5310
Provider Business Mailing Address Fax Number:
904-247-9145

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1823 3RD ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32250-7469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-241-5310
Provider Business Practice Location Address Fax Number:
904-247-9145
Provider Enumeration Date:
03/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WALT
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
C
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
904-241-5310

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  NOT REQUIRED , 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: 00440587 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: R8467 . This is a "BC/BS PROVIDER#" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 00719672A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1684716 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7701843 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: DM0962 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0226824000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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