1477605939 NPI number — GASTROENTEROLOGY ASSOC. OF SARASOTA

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 1477605939 NPI number — GASTROENTEROLOGY ASSOC. OF SARASOTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GASTROENTEROLOGY ASSOC. OF SARASOTA
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:
FDHS
Provider Other Organization Name Type Code:
3
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:
1477605939
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2089 HAWTHORNE ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
SARASOTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34239-2308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-365-6556
Provider Business Mailing Address Fax Number:
941-365-6678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2089 HAWTHORNE ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34239-2308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-365-6556
Provider Business Practice Location Address Fax Number:
941-365-6678
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIDSON
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
941-556-1415

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , 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: 100003264 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100016526 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100003263 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00092139 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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