1386901999 NPI number — ADVANCED CARE THERAPY SERVICES, LLC

Table of content: THOMAS BARTLEY PICKRON JR. M.D. (NPI 1598733941)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386901999 NPI number — ADVANCED CARE THERAPY SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED CARE THERAPY SERVICES, 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:
1386901999
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9860 BEACH BLVD
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32246-4704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9860 BEACH BLVD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32246-4704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-866-0219
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/19/2012

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALES
Authorized Official First Name:
ARLEXIS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
904-866-0219

Provider Taxonomy Codes

  • Taxonomy code: 261QR0401X , with the licence number:  PT21846 , 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)





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