1174863757 NPI number — TOTAL PATIENT CARE OF OCALA, INC.

Table of content: REBECCA ANTAYA RDN, IBCLC (NPI 1669952289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174863757 NPI number — TOTAL PATIENT CARE OF OCALA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOTAL PATIENT CARE OF OCALA, 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:
1174863757
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3320 SW 33RD ROAD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
OCALA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34474-7427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-512-0970
Provider Business Mailing Address Fax Number:
352-512-0962

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3320 SW 33RD ROAD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34474-7427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-512-0970
Provider Business Practice Location Address Fax Number:
352-512-0962
Provider Enumeration Date:
02/19/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SACHER
Authorized Official First Name:
MARK
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
352-512-0970

Provider Taxonomy Codes

  • Taxonomy code: 207LA0401X , with the licence number:  OS7127 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: OS7127 , 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: 257898100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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