1265618672 NPI number — HETHER ACCIDENT & INJURY CENTER

Table of content: DR. BONITA HAZEL SIEGEL M.D. (NPI 1245268093)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265618672 NPI number — HETHER ACCIDENT & INJURY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HETHER ACCIDENT & INJURY CENTER
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:
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:
1265618672
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3959 S NOVA RD
Provider Second Line Business Mailing Address:
SUITE 9B
Provider Business Mailing Address City Name:
PORT ORANGE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32127-9278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3959 S NOVA RD
Provider Second Line Business Practice Location Address:
SUITE 9B
Provider Business Practice Location Address City Name:
PORT ORANGE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32127-9278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-761-4001
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HETHER
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
386-761-4001

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH7306 , 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)





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