1255357232 NPI number — SYMPHONY RESPIRATORY SERVICES

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 1255357232 NPI number — SYMPHONY RESPIRATORY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SYMPHONY RESPIRATORY SERVICES
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:
GOLDEN CARE OF HAYWARD
Provider Other Organization Name Type Code:
3
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:
1255357232
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3500 FINANCIAL PLZ
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
TALLAHASSEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32312-3999
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-786-8017
Provider Business Mailing Address Fax Number:
888-447-1466

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15748 W COUNTY ROAD B
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
HAYWARD
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54843-2653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-634-9926
Provider Business Practice Location Address Fax Number:
715-638-2307
Provider Enumeration Date:
07/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FUTCH
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
850-325-7777

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  004-0000467099-01 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 41685700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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