1093930919 NPI number — O&P ASSOCIATES OF CHARLOTTE CTY INC.

Table of content: (NPI 1093930919)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093930919 NPI number — O&P ASSOCIATES OF CHARLOTTE CTY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
O&P ASSOCIATES OF CHARLOTTE CTY 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:
1093930919
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21216 OLEAN BLVD STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT CHARLOTTE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33952-6722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-629-9689
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21216 OLEAN BLVD STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT CHARLOTTE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33952-6722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-629-9689
Provider Business Practice Location Address Fax Number:
941-629-9693
Provider Enumeration Date:
04/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
G
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
941-629-9689

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , with the licence number:  POR105 , 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: CO8454429 . This is a "MEDICARE SUBMITTER ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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