1235152604 NPI number — BIOFEEDBACK ASSOCIATES OF NE FL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235152604 NPI number — BIOFEEDBACK ASSOCIATES OF NE FL

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
BIOFEEDBACK ASSOCIATES OF NE FL
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:
1235152604
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11512 LAKE MEAD AVE
Provider Second Line Business Mailing Address:
SUITE 703
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-646-0054
Provider Business Mailing Address Fax Number:
904-646-0930

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11512 LAKE MEAD AVE
Provider Second Line Business Practice Location Address:
SUITE 703
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-646-0054
Provider Business Practice Location Address Fax Number:
904-646-0930
Provider Enumeration Date:
07/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
THARP-WRIGHT
Authorized Official First Name:
ANNETTE
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
OWNER/ COUNSELOR
Authorized Official Telephone Number:
904-646-0054

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MH6843 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: SW1447 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: SW2527 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: MH4616 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: MH5132 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: MH5155 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: MH2969 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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