1306905948 NPI number — OCALA HAND CENTER, LLC

Table of content: (NPI 1306905948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306905948 NPI number — OCALA HAND CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OCALA HAND CENTER, 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:
1306905948
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9074
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAST
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04915-9074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-369-1099
Provider Business Mailing Address Fax Number:
352-369-0299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2640 SW 32ND PLACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34471-7847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-369-1099
Provider Business Practice Location Address Fax Number:
352-369-0299
Provider Enumeration Date:
12/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GUPTA
Authorized Official First Name:
NIRAV
Authorized Official Middle Name:
Authorized Official Title or Position:
PRINCIPAL
Authorized Official Telephone Number:
352-369-1099

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  OS9484 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207XS0106X , with the licence number: OS9535 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: PO3280 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 56088 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P00442268 . This is a "MEDICARE RR PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 16973 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 24419 . This is a "BCBS GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 276069000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: DG5713 . This is a "MEDICARE RR GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 002551300 . 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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