1568590719 NPI number — WEST FLORIDA MEDICAL SPECIALISTS PA

Table of content: (NPI 1568590719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568590719 NPI number — WEST FLORIDA MEDICAL SPECIALISTS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST FLORIDA MEDICAL SPECIALISTS 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:
1568590719
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5622 MARINE PKWY STE 14
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW PORT RICHEY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34652-4330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-846-7031
Provider Business Mailing Address Fax Number:
727-846-9444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5622 MARINE PKWY
Provider Second Line Business Practice Location Address:
SUITE 14
Provider Business Practice Location Address City Name:
NEW PORT RICHEY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34652-4333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-846-7031
Provider Business Practice Location Address Fax Number:
727-846-7132
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FREEDLAND
Authorized Official First Name:
CURTIS
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
727-846-7031

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000946500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 39190 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: CN1580 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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