1427279611 NPI number — DR. SUDHIR HANSALIA MD

Table of content: DR. SUDHIR HANSALIA MD (NPI 1427279611)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427279611 NPI number — DR. SUDHIR HANSALIA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANSALIA
Provider First Name:
SUDHIR
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1427279611
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5000 PARK ST N STE 1017
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33709-2236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-344-6570
Provider Business Mailing Address Fax Number:
727-384-4388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3611 LITTLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRINITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34655-1813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-312-4300
Provider Business Practice Location Address Fax Number:
727-413-4335
Provider Enumeration Date:
05/02/2007

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: 207RH0003X , with the licence number:  ME114725 , 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: 018165100 . This is a "FLORIDA MEDICAID ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: KX084 . This is a "MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: KX085 . This is a "MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 6VBQR . This is a "BCBS FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 8528341 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com