1073623674 NPI number — M FRANCISCO GONZALEZ, MD, PA

Table of content: HEATHER DYEANN HOYAL PH.D. (NPI 1881829679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073623674 NPI number — M FRANCISCO GONZALEZ, MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
M FRANCISCO GONZALEZ, MD, 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:
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:
1073623674
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 N SUMTER ST
Provider Second Line Business Mailing Address:
SUITE 305
Provider Business Mailing Address City Name:
SUMTER
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29150-4972
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-934-8348
Provider Business Mailing Address Fax Number:
803-934-8349

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 N SUMTER ST
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
SUMTER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29150-4972
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-934-8348
Provider Business Practice Location Address Fax Number:
803-934-8349
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOBBS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
803-779-6610

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  9747 , 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: GP4045 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8579 . This is a "MEDICARE GROUP PIN" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: GP3381 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com