1720125479 NPI number — BEACH MEDICAL SPECIALIST PA

Table of content: PATRICIA ANNE MAURER LBSW (NPI 1073631669)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720125479 NPI number — BEACH MEDICAL SPECIALIST PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEACH MEDICAL SPECIALIST 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:
1720125479
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9860 BEACH BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32246-4704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-200-2978
Provider Business Mailing Address Fax Number:
904-807-9114

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9860 BEACH BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32246-4704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-200-2978
Provider Business Practice Location Address Fax Number:
904-807-9114
Provider Enumeration Date:
01/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DIZON
Authorized Official First Name:
ALEJANDRO
Authorized Official Middle Name:
CABIGTING
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
904-200-2978

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME88405 , 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: 272420100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004236100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com