1508029349 NPI number — CHARLES R HABELOW MD PA

Table of content: (NPI 1508029349)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508029349 NPI number — CHARLES R HABELOW MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLES R HABELOW MD PA
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:
1508029349
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 510310
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PUNTA GORDA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33951-0310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-494-2293
Provider Business Mailing Address Fax Number:
863-494-1520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 N BREVARD AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
ARCADIA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34266-4501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-494-2293
Provider Business Practice Location Address Fax Number:
863-494-1520
Provider Enumeration Date:
07/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HABELOW
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
863-494-2293

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME49217 , 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: DN9810 . This is a "RAILROAD MEDICARE B PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 046638701 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1881601946 . This is a "NPI, TYPE I" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1508029349 . This is a "NPI , TYPE II" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com