1346563368 NPI number — NEUROLOGY ASSOCIATES OF SEBRING, PA

Table of content: (NPI 1346563368)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346563368 NPI number — NEUROLOGY ASSOCIATES OF SEBRING, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUROLOGY ASSOCIATES OF SEBRING, 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:
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:
1346563368
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4325 SUN N LAKE BLVD
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
SEBRING
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33872-2171
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-402-0066
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4325 SUN N LAKE BLVD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
SEBRING
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33872-2171
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-402-0066
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/04/2010

Additional Information

Authorized Official

Authorized Official Last Name:
RAMKISSOON
Authorized Official First Name:
BRIDGLAL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
863-402-0066

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 007598800 . 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