1295730216 NPI number — AMPUTEE CLINIC, INC.

Table of content: WINSTON ALBERT BROWN II (NPI 1447148143)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295730216 NPI number — AMPUTEE CLINIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMPUTEE CLINIC, INC.
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:
1295730216
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7051 CYPRESS TER
Provider Second Line Business Mailing Address:
#108
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33907-8822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-437-4010
Provider Business Mailing Address Fax Number:
239-437-4097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7051 CYPRESS TER
Provider Second Line Business Practice Location Address:
#108
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33907-8822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-437-4010
Provider Business Practice Location Address Fax Number:
239-437-4097
Provider Enumeration Date:
06/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RANDALL
Authorized Official First Name:
MARCUM
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT PT CP LPO
Authorized Official Telephone Number:
239-437-4010

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 009939684 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 81750 . This is a "NORTHWOOD (BC/BS MI DME)" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 204925600 . This is a "TVA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 8150 . This is a "NORTHWOOD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1454256 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 52895744 001 . This is a "GEORGIA HEALTH PARTNERSHI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1295730216 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000914064A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004016999 . This is a "BC/BS OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 13125 . This is a "PHP, CARITEN, PHP TENNCAR" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4016999 . This is a "BC/BS TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com