1336578251 NPI number — ALLEGIANCE ORTHOPAEDIC & SPINE INSTITUTE PLLC

Table of content: (NPI 1336578251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336578251 NPI number — ALLEGIANCE ORTHOPAEDIC & SPINE INSTITUTE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLEGIANCE ORTHOPAEDIC & SPINE INSTITUTE PLLC
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:
1336578251
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 NW 1ST AVE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
DELRAY BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33444-2684
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-409-9309
Provider Business Mailing Address Fax Number:
561-431-8184

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 NW 1ST AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
DELRAY BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33444-2684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-409-9309
Provider Business Practice Location Address Fax Number:
561-431-8184
Provider Enumeration Date:
11/01/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
561-409-9309

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME86962 , 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: 010360100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com