1548280092 NPI number — YILI ZHOU LLC

Table of content: (NPI 1548280092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548280092 NPI number — YILI ZHOU LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YILI ZHOU 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:
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:
1548280092
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5525 BANANA POINT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKAHUMPKA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34762-3334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-331-0909
Provider Business Mailing Address Fax Number:
352-331-0970

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6830 NW 11TH PL
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32605-4254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-331-0909
Provider Business Practice Location Address Fax Number:
352-331-0970
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ZHOU
Authorized Official First Name:
YILI
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
352-331-0909

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X , with the licence number:  ME86840 , 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: P00264488/DD9858 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 265587000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 265587001 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 287725 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 47853 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7281245 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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