1457375479 NPI number — ANIL M BHATIA M.D.

Table of content: JESSICA RENEE MORRIS (NPI 1225816416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457375479 NPI number — ANIL M BHATIA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BHATIA
Provider First Name:
ANIL
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1457375479
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 46577
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33646-0105
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:
14447 UNIVERSITY COVE PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33613-3741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-975-1501
Provider Business Practice Location Address Fax Number:
813-608-5349
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME 0073647 , 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: 10334501 . This is a "CITRUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 542087068 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: ME0073647 . This is a "MEDICAL LIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 42270B . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 542087068 . This is a "TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 594572 . This is a "AVMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 253294800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 04-10158 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2077393 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 542087068 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 542087068 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: N266961 . This is a "WELLCARE" identifier . This identifiers is of the category "OTHER".




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