1194700823 NPI number — DR. STEPHEN MARK ROSS MD,PHD

Table of content: DR. STEPHEN MARK ROSS MD,PHD (NPI 1194700823)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194700823 NPI number — DR. STEPHEN MARK ROSS MD,PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSS
Provider First Name:
STEPHEN
Provider Middle Name:
MARK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD,PHD
Provider Gender Code:
M

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:
1194700823
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 380877
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURDOCK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33938-0877
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-979-5200
Provider Business Mailing Address Fax Number:
941-979-5201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6150 MANASOTA KEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34223-9253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-571-0350
Provider Business Practice Location Address Fax Number:
410-571-7069
Provider Enumeration Date:
12/15/2005

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: 261QR0200X , with the licence number:  HCC8516 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP3300X , with the licence number: PMC1621 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP3300X , with the licence number: PMC1664 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP3300X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP3300X , with the licence number: PMC1756 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: ME75401L , 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: 262392700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4213 . This is a "HEALTH CARE CLINIC PERMIT" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: PMC1664 . This is a "PAIN MANAGEMENT" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 35702L . This is a "MEDICARE PERSONAL PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: PMC1756 . This is a "PAIN MANAGEMENT" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: FK751A . This is a "MEDICARE PTAN SAR PAIN INSTITUTE LLC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 150492200863 . This is a "HUMANA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: HCC8516 . This is a "AHCA RX FOR IMAGING" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: CO744 . This is a "RX FOR IMAGING MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 213119 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: PMC1148 . This is a "PAIN MANAGEMENT CLINIC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: V2822 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: PMC1621 . This is a "PAIN MANAGEMENT" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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