1295019990 NPI number — NORTH CENTRAL FLORIDA NEURODIAGNOSTIC SERVICES, LLC

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 1295019990 NPI number — NORTH CENTRAL FLORIDA NEURODIAGNOSTIC SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH CENTRAL FLORIDA NEURODIAGNOSTIC SERVICES, LLC
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:
NCF DIAGNOSTICS & DNA TECHNOLOGIES
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:
1295019990
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2459
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALACHUA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32616-2459
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-375-5553
Provider Business Mailing Address Fax Number:
888-972-4494

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12076 TECHNOLOGY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALACHUA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-375-5553
Provider Business Practice Location Address Fax Number:
352-505-5506
Provider Enumeration Date:
09/30/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HARPER
Authorized Official First Name:
ADRIAN
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
352-375-5553

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  800026857 , 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: 10D2042485 . This is a "CMS/CLIA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 8004802 . This is a "COLLEGE OF AMERICAN PATHOLOGISTS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 800026857 . This is a "CLINICAL LABORATORY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 605678 . This is a "THE JOINT COMMISSION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 010659900 . 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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