1235332354 NPI number — JAMES G HANKERSON PA

Table of content: (NPI 1235332354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235332354 NPI number — JAMES G HANKERSON PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES G HANKERSON 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:
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:
1235332354
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 864241
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:
32886-4241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-884-7205
Provider Business Mailing Address Fax Number:
913-696-7141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2727 W. MARTIN LUTHER KING BLVD.
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33607-6383
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-885-6666
Provider Business Practice Location Address Fax Number:
913-341-5797
Provider Enumeration Date:
06/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HANKERSON
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
813-362-3718

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 39005 . This is a "BCBS OF FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 278591900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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