1801293626 NPI number — INTUITIVE NETWORKING

Table of content: (NPI 1801293626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801293626 NPI number — INTUITIVE NETWORKING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTUITIVE NETWORKING
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:
1801293626
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 E GRANADA BLVD
Provider Second Line Business Mailing Address:
SUITE #202
Provider Business Mailing Address City Name:
ORMOND BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32176-6603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-256-1492
Provider Business Mailing Address Fax Number:
386-753-3622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 E GRANADA BLVD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
ORMOND BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32176-6603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-256-1492
Provider Business Practice Location Address Fax Number:
386-753-3622
Provider Enumeration Date:
11/21/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SHELL
Authorized Official First Name:
DARRELL
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
FOUNDER/BUSINESS DEVELOPMENT MGR
Authorized Official Telephone Number:
386-453-4807

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X , with the licence number:  010579300 , 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: 010579300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010579600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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