1295019990 NPI number — NORTH CENTRAL FLORIDA NEURODIAGNOSTIC SERVICES, LLC

Table of content: (NPI 1295019990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295019990 NPI number — NORTH CENTRAL FLORIDA NEURODIAGNOSTIC SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH CENTRAL FLORIDA NEURODIAGNOSTIC SERVICES, 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:
1295019990
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2459
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALACHUA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32616-2459
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-375-5553
Provider Business Mailing Address Fax Number:
888-972-4494

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12076 TECHNOLOGY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALACHUA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-375-5553
Provider Business Practice Location Address Fax Number:
352-505-5506
Provider Enumeration Date:
09/30/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HARPER
Authorized Official First Name:
ADRIAN
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
352-375-5553

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  800026857 , 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: 10D2042485 . This is a "CMS/CLIA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 8004802 . This is a "COLLEGE OF AMERICAN PATHOLOGISTS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 800026857 . This is a "CLINICAL LABORATORY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 605678 . This is a "THE JOINT COMMISSION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 010659900 . 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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