1811484751 NPI number — DOCTORS INN ONE INC

Table of content: (NPI 1811484751)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811484751 NPI number — DOCTORS INN ONE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOCTORS INN ONE 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:
CARINE FAMILY MEDICINE
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:
1811484751
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2410 NORTHSIDE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33761-2236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-499-0356
Provider Business Mailing Address Fax Number:
727-781-3312

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1811 SHORE DR S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
S PASADENA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-391-4100
Provider Business Practice Location Address Fax Number:
727-398-2067
Provider Enumeration Date:
04/17/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CARINE
Authorized Official First Name:
EHREN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
727-391-4100

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  OS , 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)