1073528477 NPI number — THE NEUROSURGICAL GROUP SISCO & TIPPETT CHAPLEAU & FRANK

Table of content: (NPI 1073528477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073528477 NPI number — THE NEUROSURGICAL GROUP SISCO & TIPPETT CHAPLEAU & FRANK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE NEUROSURGICAL GROUP SISCO & TIPPETT CHAPLEAU & FRANK
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:
1073528477
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1717 N E ST
Provider Second Line Business Mailing Address:
SUITE 401
Provider Business Mailing Address City Name:
PENSACOLA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32501-6378
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-444-7050
Provider Business Mailing Address Fax Number:
850-434-8879

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1717 N E ST
Provider Second Line Business Practice Location Address:
SUITE 422
Provider Business Practice Location Address City Name:
PENSACOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32501-6339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-444-7050
Provider Business Practice Location Address Fax Number:
850-434-8879
Provider Enumeration Date:
07/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHAPLEAU
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT-DIRECTOR
Authorized Official Telephone Number:
850-444-7050

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 036686200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 013815300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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