1023210986 NPI number — NORTH FL ARTHRITIS CLINIC, PA.

Table of content: (NPI 1023210986)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023210986 NPI number — NORTH FL ARTHRITIS CLINIC, PA.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH FL ARTHRITIS CLINIC, 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:
Provider Other Organization Name Type Code:
6
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:
1023210986
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4551 W EST US 90
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
LAKE CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-719-6520
Provider Business Mailing Address Fax Number:
386-719-6592

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4551 W EST US 90
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
LAKE CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-719-6520
Provider Business Practice Location Address Fax Number:
386-719-6592
Provider Enumeration Date:
06/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CICERO
Authorized Official First Name:
SUSANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
386-719-6520

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME70903 , 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: 32116 . This is a "BC/BS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com