1154423416 NPI number — ROBERT B SCOTT OCULARISTS OF FLORIDA

Table of content: (NPI 1154423416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154423416 NPI number — ROBERT B SCOTT OCULARISTS OF FLORIDA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT B SCOTT OCULARISTS OF FLORIDA
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:
1154423416
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/06/2009
NPI Reactivation Date:
07/20/2009

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 N WABASH AVE
Provider Second Line Business Mailing Address:
SUITE 1516
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60602-3066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-782-3558
Provider Business Mailing Address Fax Number:
312-372-4449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3500 E FLETCHER AVE
Provider Second Line Business Practice Location Address:
SUITE 509
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33613-4793
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-977-7676
Provider Business Practice Location Address Fax Number:
813-977-1999
Provider Enumeration Date:
09/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCOTT
Authorized Official First Name:
BONNY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OFFICE MANAGER/TREASURER
Authorized Official Telephone Number:
312-782-3558

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 231983 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: N3179 . This is a "WELLCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: N3179 . This is a "HEALTHEASE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4017986 . This is a "BCBS TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 027891200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 214220 . This is a "AVMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: N3179 . This is a "STAYWELL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2436832 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: M0331 . This is a "BSBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10633501 . This is a "CITRUS" identifier . This identifiers is of the category "OTHER".




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