1669641452 NPI number — DR. BRYCE DAVID ARNDT D.C.

Table of content: ERIN HULTGRENN RN (NPI 1760105183)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669641452 NPI number — DR. BRYCE DAVID ARNDT D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARNDT
Provider First Name:
BRYCE
Provider Middle Name:
DAVID
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

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:
1669641452
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10915 BAYMEADOWS RD
Provider Second Line Business Mailing Address:
STE 104
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32256-9130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-683-6924
Provider Business Mailing Address Fax Number:
904-379-3988

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10915 BAYMEADOWS RD
Provider Second Line Business Practice Location Address:
STE 104
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32256-9130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-683-6924
Provider Business Practice Location Address Fax Number:
904-379-3988
Provider Enumeration Date:
02/26/2008

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: 111N00000X , with the licence number:  3871 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: CH10815 , 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: 101033800 . 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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