1730198599 NPI number — MEDICAL ARTS PROFESSIONAL HEALTH SERVICES INC

Table of content: (NPI 1730198599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730198599 NPI number — MEDICAL ARTS PROFESSIONAL HEALTH SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL ARTS PROFESSIONAL HEALTH SERVICES 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:
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:
1730198599
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13215 SPRING HILL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING HILL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34609-5054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-683-0232
Provider Business Mailing Address Fax Number:
352-683-0247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13215 SPRING HILL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING HILL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34609-5054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-683-0232
Provider Business Practice Location Address Fax Number:
352-683-0247
Provider Enumeration Date:
08/07/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DIEFFENBACH
Authorized Official First Name:
THAIR
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PH.D.
Authorized Official Telephone Number:
352-683-0232

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MH0002734 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: ME55252 , 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: 102120200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".