1770537953 NPI number — FACULTY ASSOCIATES, INC

Table of content: (NPI 1770537953)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770537953 NPI number — FACULTY ASSOCIATES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FACULTY ASSOCIATES, 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:
6
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:
1770537953
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 100425
Provider Second Line Business Mailing Address:
1600 SW ARCHER ROAD, D4-6
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32610-0425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-273-5800
Provider Business Mailing Address Fax Number:
352-392-3070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 E 25TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIALEAH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33013-3817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-694-5400
Provider Business Practice Location Address Fax Number:
305-394-2394
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GARCIA
Authorized Official First Name:
ANA
Authorized Official Middle Name:
ISABEL
Authorized Official Title or Position:
DEAN
Authorized Official Telephone Number:
352-273-5800

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 073969308 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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