1346481520 NPI number — GARY A. GOERG, DC, PA

Table of content: (NPI 1346481520)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346481520 NPI number — GARY A. GOERG, DC, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GARY A. GOERG, DC, PA
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:
1346481520
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2496 CARING WAY
Provider Second Line Business Mailing Address:
UNIT B
Provider Business Mailing Address City Name:
PORT CHARLOTTE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33952-5336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-235-3535
Provider Business Mailing Address Fax Number:
941-235-3550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2496 CARING WAY
Provider Second Line Business Practice Location Address:
UNIT B
Provider Business Practice Location Address City Name:
PORT CHARLOTTE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33952-5336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-235-3535
Provider Business Practice Location Address Fax Number:
941-235-3550
Provider Enumeration Date:
03/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GOERG
Authorized Official First Name:
GARY
Authorized Official Middle Name:
ANTON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
941-235-3535

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH7167 , 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: K8198 . This is a "GROUP IDENTIFICATION NUMBER PER CCN:920515184914" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: U63581 . This is a "UPIN PER CCN: 920515184914" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 55458Z . This is a "PROVIDER NUMBER PER CCN: 920515184914" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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