1336312925 NPI number — DR. LEONARD M LINARDOS D.C.

Table of content: DR. LEONARD M LINARDOS D.C. (NPI 1336312925)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336312925 NPI number — DR. LEONARD M LINARDOS D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LINARDOS
Provider First Name:
LEONARD
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LINARDOS
Provider Other First Name:
LENNY
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336312925
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1817 US HIGHWAY 19
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLIDAY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34691-5536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-937-6422
Provider Business Mailing Address Fax Number:
727-937-6769

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1817 US HIGHWAY 19
Provider Second Line Business Practice Location Address:
1817 US HWY 19 SOUTH
Provider Business Practice Location Address City Name:
HOLIDAY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34691-5536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-937-6422
Provider Business Practice Location Address Fax Number:
727-937-6769
Provider Enumeration Date:
04/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH8507 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NR0200X , with the licence number: CH8507 , 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: 1336312925 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 381634600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101954500 . 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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