1245429703 NPI number — DR ALPHONSE R TRIBUIANI PA

Table of content: (NPI 1245429703)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245429703 NPI number — DR ALPHONSE R TRIBUIANI PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR ALPHONSE R TRIBUIANI 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:
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:
1245429703
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9250 CORKSCREW RD STE 7
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ESTERO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33928-3216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-949-2121
Provider Business Mailing Address Fax Number:
239-597-5388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9250 CORKSCREW RD STE 7
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ESTERO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33928-3216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-959-2121
Provider Business Practice Location Address Fax Number:
239-597-5388
Provider Enumeration Date:
10/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TRIBUIANI
Authorized Official First Name:
ALPHONSE
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
239-949-2121

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  PO2858 , 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: 480030357 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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