1376809731 NPI number — ELECTROSTIM MEDICAL SERVICES, INC.

Table of content: (NPI 1376809731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376809731 NPI number — ELECTROSTIM MEDICAL SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELECTROSTIM MEDICAL SERVICES, INC.
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:
1376809731
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3504 CRAGMONT DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33619-8336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
171 ASSOCIATE LN
Provider Second Line Business Practice Location Address:
SUITE C 5
Provider Business Practice Location Address City Name:
INDIAN TRAIL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28079-7627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-588-8383
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/10/2012

Additional Information

Authorized Official

Authorized Official Last Name:
CIELO
Authorized Official First Name:
ROSSANA
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT OF BUSINESS DEVELOPM
Authorized Official Telephone Number:
813-817-4973

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  01787 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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