1497053920 NPI number — ANP GROUP LLC

Table of content: (NPI 1497053920)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497053920 NPI number — ANP GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANP GROUP LLC
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:
1497053920
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5335 MAIN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWPORT RICHEY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34653
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-845-8000
Provider Business Mailing Address Fax Number:
727-845-8008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5335 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW PORT RICHEY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34652-2510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-845-8000
Provider Business Practice Location Address Fax Number:
727-845-8008
Provider Enumeration Date:
03/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
VARGHESE
Authorized Official First Name:
BIJU
Authorized Official Middle Name:
ERALY
Authorized Official Title or Position:
MANAGER/OWNER
Authorized Official Telephone Number:
727-845-8000

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PH25114 , 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: 004120600 . 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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