1003141383 NPI number — WOODLANDS MEDICAL SPECIALISTS P A

Table of content: (NPI 1003141383)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003141383 NPI number — WOODLANDS MEDICAL SPECIALISTS P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOODLANDS MEDICAL SPECIALISTS P A
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:
1003141383
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4724 N DAVIS HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENSACOLA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32503-2339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-696-4000
Provider Business Mailing Address Fax Number:
850-434-2647

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2120 E JOHNSON AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
PENSACOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32514-6036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-475-2230
Provider Business Practice Location Address Fax Number:
850-434-2647
Provider Enumeration Date:
10/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
TAN
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRES
Authorized Official Telephone Number:
850-696-4000

Provider Taxonomy Codes

  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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