1477548808 NPI number — ELIZABETH F CALLAHAN M.D., LLC

Table of content: ELIZABETH F CALLAHAN M.D., LLC (NPI 1477548808)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477548808 NPI number — ELIZABETH F CALLAHAN M.D., LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CALLAHAN
Provider First Name:
ELIZABETH
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D., LLC
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:
1477548808
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7978 COOPER CREEK BLVD
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
UNIVERSITY PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34201-2141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-308-7546
Provider Business Mailing Address Fax Number:
941-308-7550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7978 COOPER CREEK BLVD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
UNIVERSITY PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34201-2141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-308-7546
Provider Business Practice Location Address Fax Number:
941-308-7550
Provider Enumeration Date:
09/12/2005

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: 174400000X , with the licence number:  ME89181 , 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: 1376576454 . This is a "GROUP NPI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 48310 . This is a "BC PROVIDER#" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 00A58 . This is a "BCBS GROUP ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 145A6 . This is a "JANELLE BC#" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: ME89181 . This is a "ST LICENSE#" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 00A58 . This is a "BC/BS GROUP PRACTICE PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 10D1031789 . This is a "CLIA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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