1497720700 NPI number — MEDICAL CENTER ON THE GULF LLC

Table of content: (NPI 1497720700)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497720700 NPI number — MEDICAL CENTER ON THE GULF LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL CENTER ON THE GULF 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:
1497720700
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1921
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUNEDIN
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34697-1921
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-738-0220
Provider Business Mailing Address Fax Number:
727-734-7072

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30522 US 19 N STE 109
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALM HARBOR
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34684-4436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-738-0220
Provider Business Practice Location Address Fax Number:
727-734-7072
Provider Enumeration Date:
02/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SOM
Authorized Official First Name:
ANANDA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHAIRMAN
Authorized Official Telephone Number:
727-738-0220

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110239219 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: K8814 . This is a "GRP #" identifier . This identifiers is of the category "OTHER".
  • Identifier: P2746142 . This is a "OXFORD HEALTH INSURANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 244046 . This is a "AVMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 254433400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 410972 . This is a "TUFTS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5306646 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1627837 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 213422 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3087332 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 43705 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0407698 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 276208100 . 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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