1437398674 NPI number — ARTHRITIS AND SPORTSCARE CENTER INC

Table of content: (NPI 1437398674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437398674 NPI number — ARTHRITIS AND SPORTSCARE CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARTHRITIS AND SPORTSCARE CENTER 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:
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:
1437398674
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2917 HIGHWAY 77
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PANAMA CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32405-5013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-873-6748
Provider Business Mailing Address Fax Number:
850-913-1820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2917 HIGHWAY 77
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PANAMA CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-873-6748
Provider Business Practice Location Address Fax Number:
850-913-1820
Provider Enumeration Date:
02/11/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CRAYTON
Authorized Official First Name:
HULON
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
850-873-6748

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 256011900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com