1184875007 NPI number — LOUIS STERN MD PA

Table of content: (NPI 1184875007)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184875007 NPI number — LOUIS STERN MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOUIS STERN MD PA
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:
1184875007
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
117 WEST UNDERWOOD STREET
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-894-8994
Provider Business Mailing Address Fax Number:
407-843-8490

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 W UNDERWOOD ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32806-1137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-894-8994
Provider Business Practice Location Address Fax Number:
407-843-8490
Provider Enumeration Date:
10/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
STERN
Authorized Official First Name:
LOUIS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
407-843-8994

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME0043529 , 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: 035670100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 266768679 . This is a "TRICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 30842 . This is a "BLUE CROSS BLUE SHIELD OF FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P00069500 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com