1982688628 NPI number — NORTH FLORIDA SURGICAL ASSOCIATES LLC

Table of content: (NPI 1982688628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982688628 NPI number — NORTH FLORIDA SURGICAL ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH FLORIDA SURGICAL ASSOCIATES LLC
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:
1982688628
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 HEALTH PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-4525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-372-5426
Provider Business Mailing Address Fax Number:
866-831-4898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1121 NW 64TH TER
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32605-4243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-331-3583
Provider Business Practice Location Address Fax Number:
352-331-3669
Provider Enumeration Date:
12/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RODKEY
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
MARK
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
850-523-3816

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 275341300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com