1013278662 NPI number — SARASOTA MANATEE GERIATRICS LLC

Table of content: (NPI 1013278662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013278662 NPI number — SARASOTA MANATEE GERIATRICS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SARASOTA MANATEE GERIATRICS 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:
1013278662
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8466 LOCKWOOD RIDGE RD
Provider Second Line Business Mailing Address:
NUM 160
Provider Business Mailing Address City Name:
SARASOTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34243-2951
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-228-0270
Provider Business Mailing Address Fax Number:
941-460-5448

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5120 CANTERBURY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34243-4705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-919-1593
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/30/2012

Additional Information

Authorized Official

Authorized Official Last Name:
FLETCHER
Authorized Official First Name:
RENEE
Authorized Official Middle Name:
HOPE
Authorized Official Title or Position:
ARNP
Authorized Official Telephone Number:
206-919-1593

Provider Taxonomy Codes

  • Taxonomy code: 363LG0600X , with the licence number:  ARNP3186252 , 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)





Copyright © 2007-2025 www.npivalidator.com