1275072605 NPI number — TAMMY BIRBECK DO PLLC

Table of content: (NPI 1275072605)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275072605 NPI number — TAMMY BIRBECK DO PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAMMY BIRBECK DO PLLC
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:
1275072605
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2061 ENGLEWOOD RD
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
ENGLEWOOD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34223-1749
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-408-3537
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 PINE ST STE 111A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34223-4457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-681-2042
Provider Business Practice Location Address Fax Number:
941-208-5982
Provider Enumeration Date:
02/17/2017

Additional Information

Authorized Official

Authorized Official Last Name:
BIRBECK
Authorized Official First Name:
TAMMY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
941-681-2042

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  OS10000 , 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: JYT20 . This is a "FLORIDA BLUE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 101876000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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