1255784609 NPI number — J & G FLORIDA ENTERPRISES

Table of content: DR. HERBERT C WHINNA MD (NPI 1710074596)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255784609 NPI number — J & G FLORIDA ENTERPRISES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J & G FLORIDA ENTERPRISES
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:
SUTTON HOMES
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:
1255784609
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2221 LEE RD STE 13
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTER PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32789-1864
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-740-8815
Provider Business Mailing Address Fax Number:
407-740-6678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6102 SAND PINES ESTATES BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32819-7760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-207-0511
Provider Business Practice Location Address Fax Number:
321-207-0511
Provider Enumeration Date:
07/21/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MORRIS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
407-740-8815

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  AL11960 , 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: 008567100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".