1750698817 NPI number — AMBIENT HEALTHCARE OF WEST FLORIDA INC

Table of content: (NPI 1750698817)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750698817 NPI number — AMBIENT HEALTHCARE OF WEST FLORIDA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMBIENT HEALTHCARE OF WEST FLORIDA 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:
AMBIENT HEALTHCARE OF WEST FLORIDA, INC.
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:
1750698817
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1812 RIGGINS RD
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
TALLAHASSEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32308-7833
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-656-4566
Provider Business Mailing Address Fax Number:
850-656-3523

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1812 RIGGINS RD STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TALLAHASSEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32308-7833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-656-4566
Provider Business Practice Location Address Fax Number:
850-656-3523
Provider Enumeration Date:
09/09/2010

Additional Information

Authorized Official

Authorized Official Last Name:
FIELDS
Authorized Official First Name:
SHAY
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
972-475-6992

Provider Taxonomy Codes

  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X , with the licence number: PH24865 , 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: 5701621 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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