1033307285 NPI number — HARRY COTLER INC.

Table of content: (NPI 1033307285)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033307285 NPI number — HARRY COTLER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARRY COTLER INC.
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:
1033307285
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 799
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ESTERO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33929-0799
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-398-2700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23421 WALDEN CENTER DR.
Provider Second Line Business Practice Location Address:
STE. 100
Provider Business Practice Location Address City Name:
BONITA SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34134-4911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-444-0700
Provider Business Practice Location Address Fax Number:
239-444-0900
Provider Enumeration Date:
10/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COTLER
Authorized Official First Name:
HARRY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PRESIDENT/PHYSICIAN
Authorized Official Telephone Number:
239-444-0700

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X , with the licence number:  PO3942 , 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: PO3942 . This is a "LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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