1194700823 NPI number — DR. STEPHEN MARK ROSS MD,PHD

Table of content: KELLI MARIE BROWN NP-C (NPI 1750941183)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194700823 NPI number — DR. STEPHEN MARK ROSS MD,PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSS
Provider First Name:
STEPHEN
Provider Middle Name:
MARK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD,PHD
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:
1194700823
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 380877
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURDOCK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33938-0877
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-979-5200
Provider Business Mailing Address Fax Number:
941-979-5201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6150 MANASOTA KEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34223-9253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-571-0350
Provider Business Practice Location Address Fax Number:
410-571-7069
Provider Enumeration Date:
12/15/2005

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: 261QR0200X , with the licence number:  HCC8516 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP3300X , with the licence number: PMC1621 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP3300X , with the licence number: PMC1664 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP3300X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP3300X , with the licence number: PMC1756 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: ME75401L , 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: 262392700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4213 . This is a "HEALTH CARE CLINIC PERMIT" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: PMC1664 . This is a "PAIN MANAGEMENT" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 35702L . This is a "MEDICARE PERSONAL PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: PMC1756 . This is a "PAIN MANAGEMENT" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: FK751A . This is a "MEDICARE PTAN SAR PAIN INSTITUTE LLC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 150492200863 . This is a "HUMANA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: HCC8516 . This is a "AHCA RX FOR IMAGING" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: CO744 . This is a "RX FOR IMAGING MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 213119 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: PMC1148 . This is a "PAIN MANAGEMENT CLINIC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: V2822 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: PMC1621 . This is a "PAIN MANAGEMENT" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com