1295703346 NPI number — SUSAN REISINGER, MD PROF. CORP.

Table of content: (NPI 1295703346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295703346 NPI number — SUSAN REISINGER, MD PROF. CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUSAN REISINGER, MD PROF. CORP.
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:
21ST CENTURY ONCOLOGY
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:
1295703346
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2160 COLONIAL BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33907-1410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-931-7342
Provider Business Mailing Address Fax Number:
239-931-7385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3006 S MARYLAND PKWY STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89109-2219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-894-5100
Provider Business Practice Location Address Fax Number:
702-894-5108
Provider Enumeration Date:
03/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
REISINGER
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
702-894-5100

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: G1934 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: XGG007542 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: XGG007540 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: XGG007543 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100506274 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: XGG007541 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".