1427494855 NPI number — DOLPHIN RADIOLOGY PLLC

Table of content: (NPI 1427494855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427494855 NPI number — DOLPHIN RADIOLOGY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOLPHIN RADIOLOGY 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:
DOLPHIN DIAGNOSTIC IMAGING
Provider Other Organization Name Type Code:
3
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:
1427494855
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
585 MACK BAYOU RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA ROSA BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32459-3111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-267-5667
Provider Business Mailing Address Fax Number:
850-267-5666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2257 TAYLOR RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36117-7790
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-270-9914
Provider Business Practice Location Address Fax Number:
334-270-3195
Provider Enumeration Date:
05/13/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BARNETT
Authorized Official First Name:
ROSS
Authorized Official Middle Name:
W
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
850-267-5667

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , 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: 009364609 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com