1346688603 NPI number — GEORGES ANGELS

Table of content: (NPI 1346688603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346688603 NPI number — GEORGES ANGELS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGES ANGELS
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:
1346688603
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 439
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHIEFLAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32644-0439
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-949-0822
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25674 SE 19 HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLD TOWN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-949-0822
Provider Business Practice Location Address Fax Number:
352-542-4900
Provider Enumeration Date:
06/10/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCHMITZ
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
352-949-0822

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  232880 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 253Z00000X , with the licence number: 232880 , 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: 002704800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1346688603 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".