1932406469 NPI number — VASUDEVAN KIDAMBI, MD, PA

Table of content: MS. VANESSA WITHEE FNP (NPI 1093957847)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932406469 NPI number — VASUDEVAN KIDAMBI, MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VASUDEVAN KIDAMBI, MD, 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:
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:
1932406469
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 3308
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCALA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34478
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-732-2900
Provider Business Mailing Address Fax Number:
352-732-4430

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3200 SW 34 AVENUE
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34474
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-732-2900
Provider Business Practice Location Address Fax Number:
352-732-4430
Provider Enumeration Date:
02/18/2011

Additional Information

Authorized Official

Authorized Official Last Name:
KIDAMBI
Authorized Official First Name:
VASUDEVAN
Authorized Official Middle Name:
ANJORE
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
352-732-2900

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  ME0068971 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 379283800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101954700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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