1386792588 NPI number — WM DARRELL GASKINS LLC

Table of content: (NPI 1386792588)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386792588 NPI number — WM DARRELL GASKINS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WM DARRELL GASKINS 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:
6
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:
1386792588
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2335 9TH ST N STE 304
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAPLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34103-4457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-263-7750
Provider Business Mailing Address Fax Number:
239-263-1754

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2335 9TH ST N STE 304
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34103-4457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-263-7750
Provider Business Practice Location Address Fax Number:
239-263-1754
Provider Enumeration Date:
01/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VU
Authorized Official First Name:
LANI
Authorized Official Middle Name:
PHUONG
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
239-262-2020

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  997 , 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: 69G . This is a "BLUE CROSS BLUE SHIELD FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 3250454 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7681241001 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 079218700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 490000959 . This is a "RAILROAD RETIRE. MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 107619300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com