1215250535 NPI number — SUMA & DURGA PA

Table of content: (NPI 1215250535)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215250535 NPI number — SUMA & DURGA PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMA & DURGA PA
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:
ADVANCED HEALTH SPECIALISTS
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:
1215250535
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4693 MANDOLIN LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTER HAVEN
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33884-3599
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-353-1394
Provider Business Mailing Address Fax Number:
863-638-5722

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2243 NORTH BLVD W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAVENPORT
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33837-8990
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-353-1394
Provider Business Practice Location Address Fax Number:
863-638-5722
Provider Enumeration Date:
03/02/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MAGANTI
Authorized Official First Name:
DURGA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
863-968-3634

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME 96502 , 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: 277037700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 68856 . This is a "BCBS OF FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: N379567 . This is a "WELLCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1411835 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5764074 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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