1164642096 NPI number — DR. GEORGIOS HATZOUDIS M.D.

Table of content: DR. GEORGIOS HATZOUDIS M.D. (NPI 1164642096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164642096 NPI number — DR. GEORGIOS HATZOUDIS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HATZOUDIS
Provider First Name:
GEORGIOS
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1164642096
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 W SAGAMORE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEWISTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33440-3514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-983-3434
Provider Business Mailing Address Fax Number:
863-983-2139

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1138 BROADWAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELMIRA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14904-2502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-734-2695
Provider Business Practice Location Address Fax Number:
607-734-2917
Provider Enumeration Date:
04/25/2007

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: 208600000X , with the licence number:  ME144433 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X , with the licence number: 261793 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1701924 . This is a "MEDICA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 7302220 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00451957 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 12976 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4992486 . This is a "BLUE CROSS SOUTH DAKOTA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 03412282 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 370624200 . This is a "DEPT OF LABOR" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 412871051724 . This is a "PREFERRED ONE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 1164642096 . This is a "ARAZ/ AMERICA'S PPO" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 253814 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 688453000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7054 . This is a "DAKOTACARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: HP79711 . This is a "HEALTHPARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 70L87HA . This is a "BLUE CROSS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 70L87HA . This is a "CC SYSTEMS/ BLUE PLUS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 105815400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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