1225339807 NPI number — CHILDREN'S LUNG AND SLEEP SPECIALISTS PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225339807 NPI number — CHILDREN'S LUNG AND SLEEP SPECIALISTS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDREN'S LUNG AND SLEEP SPECIALISTS PA
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:
1225339807
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 540326
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32854-0326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-383-0556
Provider Business Mailing Address Fax Number:
877-898-9443

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5251 W CAMPBELL AVE
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85031-1715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-383-0556
Provider Business Practice Location Address Fax Number:
877-898-9443
Provider Enumeration Date:
11/12/2010

Additional Information

Authorized Official

Authorized Official Last Name:
AJAYI
Authorized Official First Name:
AKINYEMI
Authorized Official Middle Name:
O
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
866-383-0556

Provider Taxonomy Codes

  • Taxonomy code: 2080P0214X , with the licence number:  43211 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080S0012X , with the licence number: 43211 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1617458-7 . This is a "CORPORATION REGISTRATION" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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