1518931617 NPI number — RICHARD MOLINSKI P.A.

Table of content: RICHARD MOLINSKI P.A. (NPI 1518931617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518931617 NPI number — RICHARD MOLINSKI P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOLINSKI
Provider First Name:
RICHARD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.
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:
1518931617
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CAMP ATTERBURY
Provider Second Line Business Mailing Address:
7812 MSU DET 1
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AA
Provider Business Mailing Address Postal Code:
46124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-304-6571
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CAMP ATTERBURY
Provider Second Line Business Practice Location Address:
7812 MSU DET 1
Provider Business Practice Location Address City Name:
EDINBURGH
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-304-6571
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/15/2006

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: 363A00000X , with the licence number:  PA 2401 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207P00000X , with the licence number: PA2401 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 290271100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 970008725 . This is a "RAILROAD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 015200200 . 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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