1013183938 NPI number — KIMBERLY VAN SCRIVER MD PA

Table of content: (NPI 1013183938)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013183938 NPI number — KIMBERLY VAN SCRIVER MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIMBERLY VAN SCRIVER 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:
A PLACE FOR WOMEN
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:
1013183938
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6817 SOUTHPOINT PKWY
Provider Second Line Business Mailing Address:
SUITE 2204
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32216-6282
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-674-0022
Provider Business Mailing Address Fax Number:
904-425-0192

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6817 SOUTHPOINT PKWY
Provider Second Line Business Practice Location Address:
SUITE 2204
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32216-6282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-674-0022
Provider Business Practice Location Address Fax Number:
904-425-0192
Provider Enumeration Date:
04/30/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VAN SCRIVER
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
904-674-0022

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  ME73993 , 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)

  • Identifier: 1386658144 . This is a "NPI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1477625457 . This is a "NPI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1205898517 . This is a "NPI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".