1083742357 NPI number — DIGESTIVE AND LIVER CENTER OF FL, LLC

Table of content: (NPI 1083742357)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083742357 NPI number — DIGESTIVE AND LIVER CENTER OF FL, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIGESTIVE AND LIVER CENTER OF FL, 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:
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:
1083742357
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 N DEAN RD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32825-3710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-384-7388
Provider Business Mailing Address Fax Number:
407-384-7391

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 N DEAN RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-384-7388
Provider Business Practice Location Address Fax Number:
407-384-7391
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SEELA
Authorized Official First Name:
SRINIVAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
407-384-7388

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  ME93786 & ME93637 , 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: 3787208 . This is a "S SEELA, CIGNA ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 28608 . This is a "H SHEELA, BCBS PROVIDER #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 299120 . This is a "AMERIGROUP GROUP ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 5243121 . This is a "H SHEELA, CIGNA ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 298080 . This is a "S SEELA, WELLCARE ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 300724 . This is a "S SEELA, AVMED ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7202746 . This is a "S SEELA, AETNA ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2555472 . This is a "H SHEELA, UNITED HC ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2555475 . This is a "S SEELA, UNITED HC ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 28609 . This is a "S SEELA, BCBS PROVIDER ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 326781 . This is a "H SHEELA, WELLCARE ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7722696 . This is a "H SHEELA, AETNA INS ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 11144901 . This is a "H SHEELA, CITRUS HC ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 273851100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 273850300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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