1639276066 NPI number — ADVANCED PROSTHETICS OF AMERICA, INC.

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 1639276066 NPI number — ADVANCED PROSTHETICS OF AMERICA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED PROSTHETICS OF AMERICA, 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:
1639276066
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 650846
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75265-0846
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-330-8881
Provider Business Mailing Address Fax Number:
800-261-9537

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2763 W OLD US HWY 441
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT DORA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32757-3500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-330-8881
Provider Business Practice Location Address Fax Number:
800-261-9537
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PRICE
Authorized Official First Name:
SHERYL
Authorized Official Middle Name:
S
Authorized Official Title or Position:
DIRECTOR OF REIMBURSEMENT
Authorized Official Telephone Number:
503-493-8288

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X , with the licence number: HCC4459 , 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: 000449600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1683602 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2331574 . This is a "AETNA HMO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: M2505 . This is a "BCBS FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 82-80128 . This is a "ACM" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 51086 . This is a "BCBS MI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 9107700300 . This is a "ACESS HEALTH SOLUTIONS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 008192 . This is a "FL HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 145048 . This is a "STAYWELL, WELLCARE, HEALT" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 51086 . This is a "ABP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 211935 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 50135 . This is a "FOUNDATION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 000006879 . This is a "BEECH STREET" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 276554 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 5688143 . This is a "AETNA PPO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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