1447392360 NPI number — LISENBY LLLP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447392360 NPI number — LISENBY LLLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LISENBY LLLP
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:
1447392360
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1890 STATE ROAD 436
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
WINTER PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32792-2285
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-645-3211
Provider Business Mailing Address Fax Number:
407-628-2853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 WEST ELEVENTH STREET
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:
32401-1896
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-785-6121
Provider Business Practice Location Address Fax Number:
850-747-3696
Provider Enumeration Date:
02/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SCHULTZ
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
407-645-3211

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  AL4809 , 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: 020398001 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com