1164419172 NPI number — PALM ORTHOPEDICS, INC

Table of content: (NPI 1164419172)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164419172 NPI number — PALM ORTHOPEDICS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PALM ORTHOPEDICS, 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:
1164419172
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
883 4TH AVE N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAPLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34102-5733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-262-2797
Provider Business Mailing Address Fax Number:
239-262-8663

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
883 4TH AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34102-5733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-262-2797
Provider Business Practice Location Address Fax Number:
239-262-8663
Provider Enumeration Date:
10/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ATKINSON
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRES
Authorized Official Telephone Number:
239-262-2797

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , with the licence number:  POR 27 , 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: 202688 . This is a "WELLCARE DME" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: M0564 . This is a "BC/BS DME" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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