1265613244 NPI number — KENNETH A. NEIFIELD, M.D., P.L.

Table of content: (NPI 1265613244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265613244 NPI number — KENNETH A. NEIFIELD, M.D., P.L.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENNETH A. NEIFIELD, M.D., P.L.
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:
KENNETH A. NEIFELD, M.D.
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:
1265613244
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2191 9TH AVE N
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
SAINT PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33713-7147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-820-7778
Provider Business Mailing Address Fax Number:
727-820-7779

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2191 9TH AVE N
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
SAINT PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33713-7147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-820-7778
Provider Business Practice Location Address Fax Number:
727-820-7779
Provider Enumeration Date:
11/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CHUMBLEY
Authorized Official First Name:
TATIANA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
727-498-8699

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME64972 , 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: 373852300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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