1255383550 NPI number — FACULTY ASSOCIATES INCORPORATED

Table of content: (NPI 1255383550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255383550 NPI number — FACULTY ASSOCIATES INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FACULTY ASSOCIATES INCORPORATED
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:
FACULTY ASSOCIATES GAINESVILLE
Provider Other Organization Name Type Code:
5
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:
1255383550
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 100425
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32610-0425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-273-6700
Provider Business Mailing Address Fax Number:
352-392-3070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 SW ARCHER RD
Provider Second Line Business Practice Location Address:
D4-6
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32610-3003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-273-6700
Provider Business Practice Location Address Fax Number:
352-392-3070
Provider Enumeration Date:
05/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GARCIA
Authorized Official First Name:
ANA
Authorized Official Middle Name:
ISABEL
Authorized Official Title or Position:
DEAN
Authorized Official Telephone Number:
352-273-5802

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 073969301 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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