1477123057 NPI number — APALACHEE CENTER, INC.

Table of content: (NPI 1477123057)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477123057 NPI number — APALACHEE CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APALACHEE 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:
1477123057
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2634 CAPITAL CIR NE BLDG J
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TALLAHASSEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32308-4106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-523-3333
Provider Business Mailing Address Fax Number:
850-523-3411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
79 LASALLE PATH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUINCY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32351-5286
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-875-2422
Provider Business Practice Location Address Fax Number:
850-627-1130
Provider Enumeration Date:
06/28/2021

Additional Information

Authorized Official

Authorized Official Last Name:
LANDRUM
Authorized Official First Name:
APRIL
Authorized Official Middle Name:
DAWN
Authorized Official Title or Position:
DIRECTOR OF PATIENT FINANCIAL SRVCS
Authorized Official Telephone Number:
850-523-3243

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 060298116 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060298130 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1730289968 . This is a "NPI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 060298130 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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