1386768182 NPI number — ANTONINA FRANKS PT

Table of content: ANTONINA FRANKS PT (NPI 1386768182)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386768182 NPI number — ANTONINA FRANKS PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRANKS
Provider First Name:
ANTONINA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

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:
1386768182
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
507 W CHEVES ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29501-4449
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-662-1234
Provider Business Mailing Address Fax Number:
843-669-7144

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
507 W CHEVES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29501-4449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-662-1234
Provider Business Practice Location Address Fax Number:
843-669-7144
Provider Enumeration Date:
03/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  6870 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1386768182 . This is a "TRICARE CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1386768182 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50700031 . This is a "CARE FIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 91125801 . This is a "CARE FIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1988262 . This is a "PABS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2858132000 . This is a "IBC AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11779853 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".




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