1407170632 NPI number — SANJAY A PATEL MD PA

Table of content: (NPI 1407170632)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407170632 NPI number — SANJAY A PATEL MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANJAY A PATEL MD 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:
1407170632
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
419 SW 15TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCALA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34471-0609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-732-6400
Provider Business Mailing Address Fax Number:
352-671-5283

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
419 SW 15TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34471-0609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-732-6400
Provider Business Practice Location Address Fax Number:
352-671-5283
Provider Enumeration Date:
03/17/2010

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
KASHMIRA
Authorized Official Middle Name:
SANJAY
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
352-732-6400

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME69007 , 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: 272508800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 27591 . This is a "MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: G11717 . This is a "UPIN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 69007 . This is a "ME LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 10D0974350 . This is a "CLIA ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1003866823 . This is a "NPI ENTITY TYPE ONE ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 110204280 . This is a "RAILROAD MEDICARE ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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