1174068118 NPI number — ORLANDO CLINIC FOR ASTHMA&RESPIRATORY DISEASE

Table of content: (NPI 1174068118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174068118 NPI number — ORLANDO CLINIC FOR ASTHMA&RESPIRATORY DISEASE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORLANDO CLINIC FOR ASTHMA&RESPIRATORY DISEASE
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:
1174068118
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 ZEAGLER DR
Provider Second Line Business Mailing Address:
SUITE 6
Provider Business Mailing Address City Name:
PALATKA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32177-6806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-474-3497
Provider Business Mailing Address Fax Number:
386-350-0207

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 ZEAGLER DR
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
PALATKA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32177-6806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-474-3497
Provider Business Practice Location Address Fax Number:
386-350-0207
Provider Enumeration Date:
12/29/2016

Additional Information

Authorized Official

Authorized Official Last Name:
FEIBELMAN
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
H
Authorized Official Title or Position:
CLINICAL MANAGER
Authorized Official Telephone Number:
386-530-2749

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  ME38708 , 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: 041509000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1891729562 . This is a "NPI RICHARD Y FEIBELMANM.D." identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1265463343 . This is a "NPI ORLANDO CLINIC FOR ASTHMA&RESPIRATORY DISEASE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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