1144622242 NPI number — MEAGHAN O'BRIEN STOCKS PA-C

Table of content: MEAGHAN O'BRIEN STOCKS PA-C (NPI 1144622242)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144622242 NPI number — MEAGHAN O'BRIEN STOCKS PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOCKS
Provider First Name:
MEAGHAN
Provider Middle Name:
O'BRIEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NICHOL
Provider Other First Name:
MEAGHAN
Provider Other Middle Name:
O'BRIEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144622242
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 2147
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33902-2147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-343-2052
Provider Business Mailing Address Fax Number:
239-343-5348

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13681 DOCTORS WAY
Provider Second Line Business Practice Location Address:
SUITE 19021
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33912-4300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-424-1449
Provider Business Practice Location Address Fax Number:
239-424-1421
Provider Enumeration Date:
09/19/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA9108251 , 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: 015946800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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