1205880945 NPI number — GALENCARE, INC.

Table of content: (NPI 1205880945)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205880945 NPI number — GALENCARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GALENCARE, INC.
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:
HCA FLORIDA NORTHSIDE HOSPITAL
Provider Other Organization Name Type Code:
3
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:
1205880945
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6000 49TH ST N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33709-2114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-521-4411
Provider Business Mailing Address Fax Number:
727-521-5007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6000 49TH ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33709-2114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-521-4411
Provider Business Practice Location Address Fax Number:
727-521-5007
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REDD-HACHEY
Authorized Official First Name:
KRISTY
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
727-521-5515

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01566027 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 61097837002 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10616B , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 572 . This is a "BLUE CROSS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 211089 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036492100 . This is a "BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 300039265C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0064195 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 011519300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000030950 . This is a "HUMANA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 20019 . This is a "WELLCARE/STAYWELL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 011519300 . 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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