1972959302 NPI number — PROJECT HEALTH INC

Table of content: (NPI 1972959302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972959302 NPI number — PROJECT HEALTH INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROJECT HEALTH 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:
LANGLEY HEALTH SERVICES
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:
1972959302
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1425 S US 301
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUMTERVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33585-5141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-793-5900
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
314 S LINE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INVERNESS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34452-4606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-419-5760
Provider Business Practice Location Address Fax Number:
352-419-7085
Provider Enumeration Date:
05/04/2016

Additional Information

Authorized Official

Authorized Official Last Name:
CHASE
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
352-793-5900

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 029547724 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 681110 . This is a "MEDICARE FIRST COAST PART A" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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