1134241540 NPI number — DR KYLE D ABSHIRE & DR JAMES R HOFFMAN PA

Table of content: (NPI 1134241540)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134241540 NPI number — DR KYLE D ABSHIRE & DR JAMES R HOFFMAN PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR KYLE D ABSHIRE & DR JAMES R HOFFMAN 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:
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:
1134241540
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
905 PARK AVE
Provider Second Line Business Mailing Address:
100
Provider Business Mailing Address City Name:
ORANGE PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32073-4101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-264-1206
Provider Business Mailing Address Fax Number:
904-264-3685

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
905 PARK AVE
Provider Second Line Business Practice Location Address:
100
Provider Business Practice Location Address City Name:
ORANGE PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32073-4101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-264-1206
Provider Business Practice Location Address Fax Number:
904-264-3685
Provider Enumeration Date:
04/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HOFFMAN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
904-264-1206

Provider Taxonomy Codes

  • Taxonomy code: 152WC0802X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 45637 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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