1780827683 NPI number — MICHAEL SLOBASKY DO PA

Table of content: (NPI 1780827683)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780827683 NPI number — MICHAEL SLOBASKY DO PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL SLOBASKY DO 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:
PREMIER PAIN NETWORK
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:
1780827683
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 SW MARTIN DOWNS BLVD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALM CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34990-2861
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-735-1178
Provider Business Mailing Address Fax Number:
772-223-6354

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 SW MARTIN DOWNS BLVD STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALM CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34990-2861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-735-1178
Provider Business Practice Location Address Fax Number:
772-223-6354
Provider Enumeration Date:
04/08/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SLOBASKY
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
215-869-8777

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00A52 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".