1255706024 NPI number — GAYATRIKRUPA LLC

Table of content: (NPI 1255706024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255706024 NPI number — GAYATRIKRUPA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GAYATRIKRUPA LLC
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:
1255706024
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7217 US HIGHWAY 27 N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEBRING
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33870-1051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-427-4374
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7217 US HIGHWAY 27 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEBRING
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33870-1051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-427-4374
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/04/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
DHAVALKUMAR
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
561-427-4374

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PH29573 , 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: 016659100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2155798 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 016659100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".