1205912326 NPI number — HC HEALTHCARE INC

Table of content: (NPI 1205912326)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205912326 NPI number — HC HEALTHCARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HC HEALTHCARE 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:
TRINITY FAMILY CLINIC
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:
1205912326
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
506 NW 4TH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JASPER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32052-6603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-792-7247
Provider Business Mailing Address Fax Number:
386-792-7257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
506 NW 4TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JASPER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32052-6603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-792-7247
Provider Business Practice Location Address Fax Number:
386-792-7257
Provider Enumeration Date:
10/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KRASNOW
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
386-792-7200

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  80014936 , 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: 660106500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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