1518911031 NPI number — GALEN OF FLORIDA, INC.

Table of content: (NPI 1518911031)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518911031 NPI number — GALEN OF FLORIDA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GALEN OF FLORIDA, INC.
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:
6
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:
1518911031
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 13096
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:
33733-3096
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-384-1414
Provider Business Mailing Address Fax Number:
727-341-4889

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6500 38TH AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33710-1629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-384-1414
Provider Business Practice Location Address Fax Number:
727-341-4889
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARUSO
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
727-341-7578

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 012010300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 363591 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: STP0180N , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0473910 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 483195329A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000030901 . This is a "HUMANA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 21074 . This is a "WELLCARE/STAYWELL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 404862810 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 21074 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 558 . This is a "BLUE CROSS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 01754329 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036994000 . This is a "BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1005006 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1167499 . This is a "PASSPORT HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 122527 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 233161 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 304862800 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 012010300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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