1194706051 NPI number — ALPHA BRIDGE CONNECTIONS, LLC

Table of content: (NPI 1194706051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194706051 NPI number — ALPHA BRIDGE CONNECTIONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALPHA BRIDGE CONNECTIONS, LLC
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:
1194706051
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10150 HIGHLAND MANOR DR
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33610-9712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-558-6500
Provider Business Mailing Address Fax Number:
813-558-6572

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10150 HIGHLAND MANOR DR
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33610-9712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-558-6500
Provider Business Practice Location Address Fax Number:
813-558-6572
Provider Enumeration Date:
11/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WOOD
Authorized Official First Name:
MARILYN
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
813-558-6561

Provider Taxonomy Codes

  • Taxonomy code: 207RG0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 007530458 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 266544100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34616 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 038U0AL . This is a "BLUE CROSS BLUE SHIELD MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 001500049 . This is a "HIGHMARK BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: CK4226 . This is a "UNITED AMERICAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: CK8272 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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