1477711844 NPI number — JORGE RUIZ LLANES MD PA

Table of content: (NPI 1477711844)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477711844 NPI number — JORGE RUIZ LLANES MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JORGE RUIZ LLANES MD PA
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:
1477711844
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1240
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LECANTO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34460-1240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-794-3882
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 SE 5TH TER
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
CRYSTAL RIVER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34429-4878
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-794-3882
Provider Business Practice Location Address Fax Number:
352-794-3883
Provider Enumeration Date:
06/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RUIZ LLANES
Authorized Official First Name:
JORGE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
352-794-3882

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME94400 , 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: 276138600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com