1255389797 NPI number — PATRICK L GAROFANO P.T.

Table of content: PATRICK L GAROFANO P.T. (NPI 1255389797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255389797 NPI number — PATRICK L GAROFANO P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAROFANO
Provider First Name:
PATRICK
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
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:
1255389797
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
243 S GREENO RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRHOPE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36532-1902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-928-3909
Provider Business Mailing Address Fax Number:
251-928-3984

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
243 S GREENO RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRHOPE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36532-1902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-928-3909
Provider Business Practice Location Address Fax Number:
251-928-3984
Provider Enumeration Date:
05/05/2006

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: 225100000X , with the licence number:  PTH1112 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5588139 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9191 . This is a "HEALTH SPRING INSURANCE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 174029200 . This is a "DEPT OF LABOR/ACN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 51095742 . This is a "BLUE CROSS BLUE SHIELD AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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