1205033412 NPI number — DR. LINDSEY M WEINTRITT-DAVIS M.D.

Table of content: DR. LINDSEY M WEINTRITT-DAVIS M.D. (NPI 1205033412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205033412 NPI number — DR. LINDSEY M WEINTRITT-DAVIS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEINTRITT-DAVIS
Provider First Name:
LINDSEY
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEINTRITT
Provider Other First Name:
LINDSEY
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205033412
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1770
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PANAMA CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32402-1770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-747-4905
Provider Business Mailing Address Fax Number:
850-747-4907

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
527 N PALO ALTO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PANAMA CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32401-3639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-747-4905
Provider Business Practice Location Address Fax Number:
850-747-4907
Provider Enumeration Date:
06/29/2007

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: 207R00000X , with the licence number:  TRN11518 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: ME116548 , 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: 009142100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 14R2Y . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: HJ682Y . This is a "MEDICARE FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: HJ682Z . This is a "MEDICARE FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: HJ682X . This is a "MEDICARE FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 009142100 . 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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