1447574504 NPI number — SOALNTIC OF ORLANDO, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447574504 NPI number — SOALNTIC OF ORLANDO, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOALNTIC OF ORLANDO, 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:
1447574504
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8711 PERIMETER PARK BLVD
Provider Second Line Business Mailing Address:
SUITE 6
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32216-6388
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-223-2330
Provider Business Mailing Address Fax Number:
904-425-4356

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2415 SW COLLEGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34471-1664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-237-3536
Provider Business Practice Location Address Fax Number:
352-237-8735
Provider Enumeration Date:
03/18/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BOWLING
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
904-223-2330

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  HCC 8481 , 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)