1205807914 NPI number — FRIDLEY ROEMER HCS, INC.

Table of content: (NPI 1205807914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205807914 NPI number — FRIDLEY ROEMER HCS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRIDLEY ROEMER HCS, 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:
6
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:
1205807914
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
644 FLORIDA AVE
Provider Second Line Business Mailing Address:
UNIT E
Provider Business Mailing Address City Name:
PANAMA CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32401-6355
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-896-1387
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
644 FLORIDA AVE
Provider Second Line Business Practice Location Address:
UNIT E
Provider Business Practice Location Address City Name:
PANAMA CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32401-6355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-896-1387
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROEMER
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PROVIDER
Authorized Official Telephone Number:
850-896-1387

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  NP1376612 , 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: 1376612 . This is a "MSC. IDENTIFIER STATE LIC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: R49453 . This is a "STATE LICENSE #" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: Y6683 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 00200184549 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: TRICARE STANDARD , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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