1033137336 NPI number — MRS. PAMELA JEAN PARKS OZALUK CRNA

Table of content: MRS. PAMELA JEAN PARKS OZALUK CRNA (NPI 1033137336)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033137336 NPI number — MRS. PAMELA JEAN PARKS OZALUK CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARKS OZALUK
Provider First Name:
PAMELA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

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:
1033137336
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1303 3RD STREET CIR E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALMETTO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34221-4242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-281-2292
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3301 HARDEN STREET EXT 5 MEDICAL PARK
Provider Second Line Business Practice Location Address:
PLAMETTO HEALTH RICLAND
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-296-2548
Provider Business Practice Location Address Fax Number:
803-296-2525
Provider Enumeration Date:
07/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  2931 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: AN1517 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 117843800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com