1518978592 NPI number — SALVATORE J ARMENIA PA

Table of content: SALVATORE J ARMENIA PA (NPI 1518978592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518978592 NPI number — SALVATORE J ARMENIA PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARMENIA
Provider First Name:
SALVATORE
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
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:
1518978592
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3003 W DR MARTIN LUTHER KING JR BLVD
Provider Second Line Business Mailing Address:
MEDICAL ARTS BUILING 2ND FLOOR
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33607-6307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-875-8988
Provider Business Mailing Address Fax Number:
813-876-9827

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6006 49TH ST N
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33709-2148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-490-5044
Provider Business Practice Location Address Fax Number:
727-490-5043
Provider Enumeration Date:
08/11/2006

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: 363AS0400X , with the licence number:  PA2400 , 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: 174750 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 12159 . This is a "UNIVERSAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2122308 . This is a "HUMANA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 020724400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com