1073566899 NPI number — SLEEP ASSOCIATES OF FLORIDA LLC

Table of content: (NPI 1073566899)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073566899 NPI number — SLEEP ASSOCIATES OF FLORIDA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLEEP ASSOCIATES OF FLORIDA 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:
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:
1073566899
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35780 SR 54
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
ZEPHYRHILLS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33541-2242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-377-2250
Provider Business Mailing Address Fax Number:
813-283-6853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35780 SR 54
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
ZEPHYRHILLS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33541-2242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-377-2250
Provider Business Practice Location Address Fax Number:
813-283-6853
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KURIAKOSE
Authorized Official First Name:
ABY
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
TECHNICAL DIRECTOR
Authorized Official Telephone Number:
813-377-2250

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X , with the licence number:  HCC4205 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QS1200X , with the licence number: HCC4204 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QS1200X , with the licence number: HCC8377 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QS1200X , with the licence number: HCC4207 , 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: HCC4207 . This is a "HEALTH CARE CLINIC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: HCC4205 . This is a "HEALTH CARE CLINIC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: HCC8377 . This is a "HEALTH CARE CLINIC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P00050306 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: HCC8545 . This is a "HEALTH CARE CLINIC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: HCC4204 . This is a "HEALTH CARE CLINIC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 002538200 . 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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