1326095944 NPI number — DAWN RENE', INC.

Table of content: (NPI 1326095944)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326095944 NPI number — DAWN RENE', INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAWN RENE', INC.
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:
VERNON FAMILY HEALTH OF CHIPLEY
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:
1326095944
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
719 7TH ST STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHIPLEY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32428-1935
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-676-4287
Provider Business Mailing Address Fax Number:
850-676-4292

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
719 7TH ST STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHIPLEY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32428-1935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-676-4287
Provider Business Practice Location Address Fax Number:
850-676-4292
Provider Enumeration Date:
05/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FROST
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
RENE'
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
850-676-4287

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: AR2003622 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 108989 . This is a "MEDICARE ID-RIVERBEND" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 306088800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30289900 . This is a "MEDIPASS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: Y9052 . This is a "BC/BS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com