1679556864 NPI number — DOCTORS GI PARTNERSHIP LTD

Table of content: (NPI 1679556864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679556864 NPI number — DOCTORS GI PARTNERSHIP LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOCTORS GI PARTNERSHIP LTD
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:
HF SURGERY CENTER AT BABCOCK
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:
1679556864
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 562767
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKLEDGE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32956-2767
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-434-5491
Provider Business Mailing Address Fax Number:
321-434-5419

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5191 BABCOCK ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALM BAY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32905-4610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-434-1919
Provider Business Practice Location Address Fax Number:
321-434-5419
Provider Enumeration Date:
11/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ESROCK
Authorized Official First Name:
BRETT
Authorized Official Middle Name:
Authorized Official Title or Position:
EVP/CFO
Authorized Official Telephone Number:
321-434-5197

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  1133 , 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: 490005411 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7136337 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 075479000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6A6 . This is a "BLUE CROSS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 075479000 . 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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