1205192739 NPI number — ANASTASIA PEDIATRICS

Table of content: DR. RENEE MARIE CALKINS D.D.S. (NPI 1275954786)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205192739 NPI number — ANASTASIA PEDIATRICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANASTASIA PEDIATRICS
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:
1205192739
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
08/31/2012
NPI Reactivation Date:
04/30/2013

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 WHETSTONE PL
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
ST AUGUSTINE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32086-5774
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-819-9925
Provider Business Mailing Address Fax Number:
904-819-9926

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 WHETSTONE PL
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
ST AUGUSTINE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32086-5774
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-819-9925
Provider Business Practice Location Address Fax Number:
904-819-9926
Provider Enumeration Date:
04/10/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MANIKAL
Authorized Official First Name:
MONALI
Authorized Official Middle Name:
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
904-819-9925

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  ME0081118 , 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: 003482600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 259789600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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