1306005186 NPI number — ACCARDI CLINICAL SERVICES INC

Table of content: (NPI 1306005186)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306005186 NPI number — ACCARDI CLINICAL SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCARDI CLINICAL SERVICES 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:
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:
1306005186
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2583 S VOLUSIA AVE
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
ORANGE CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32763-9129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-774-5800
Provider Business Mailing Address Fax Number:
386-774-5656

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2583 S VOLUSIA AVE
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
ORANGE CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32763-9129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-774-5800
Provider Business Practice Location Address Fax Number:
386-774-5656
Provider Enumeration Date:
06/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ACCARDI
Authorized Official First Name:
J ROGER
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
386-774-5800

Provider Taxonomy Codes

  • Taxonomy code: 3336I0012X , with the licence number:  PH16425 , 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: 1035307 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com