1255434445 NPI number — S GOLDMAN MD C PITARYS MD PL

Table of content: (NPI 1255434445)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255434445 NPI number — S GOLDMAN MD C PITARYS MD PL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S GOLDMAN MD C PITARYS MD PL
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:
WEST FLORIDA CARDIOLOGY CONSULTANTS
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:
1255434445
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14100 FIVAY ROAD
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34667-7159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-849-8771
Provider Business Mailing Address Fax Number:
727-842-4962

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6633 FOREST AVE STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW PORT RICHEY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34653-2612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-849-8771
Provider Business Practice Location Address Fax Number:
727-842-4962
Provider Enumeration Date:
09/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GOLDMAN
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
PARTNER / PROVIDER
Authorized Official Telephone Number:
727-849-8771

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RI0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 262224600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: CH7540 . This is a "RR MCR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: F835 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 45944 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 262224600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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