1154476521 NPI number — GANAWAY & GANAWAY INC

Table of content: (NPI 1154476521)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154476521 NPI number — GANAWAY & GANAWAY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GANAWAY & GANAWAY 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:
WILLIAM T. GANAWAY PHD
Provider Other Organization Name Type Code:
3
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:
1154476521
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
818 US HIGHWAY 1
Provider Second Line Business Mailing Address:
SUITE 5
Provider Business Mailing Address City Name:
NORTH PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33408-3831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-624-3004
Provider Business Mailing Address Fax Number:
561-624-1855

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
818 US HIGHWAY 1
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
NORTH PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33408-3831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-624-3004
Provider Business Practice Location Address Fax Number:
561-624-1855
Provider Enumeration Date:
01/24/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GANAWAY
Authorized Official First Name:
LYN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
561-624-3004

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  ISW651 , 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)