1346484565 NPI number — DIGESTIVE DISEASES CARE FOR ALL 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 1346484565 NPI number — DIGESTIVE DISEASES CARE FOR ALL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIGESTIVE DISEASES CARE FOR ALL 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:
Provider Other Organization Name Type Code:
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:
1346484565
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 249
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGHLAND CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33846-0249
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-687-8335
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
805 EAST GARDEN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKELAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33805-4616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-802-1111
Provider Business Practice Location Address Fax Number:
863-802-6711
Provider Enumeration Date:
05/01/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HAQUE
Authorized Official First Name:
MAHMUDUL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
863-802-1111

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: ME93947 , 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: 274846100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".