1578505103 NPI number — SAMKIN GLOBAL, INC.

Table of content: (NPI 1578505103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578505103 NPI number — SAMKIN GLOBAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAMKIN GLOBAL, INC.
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:
1578505103
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3948 SUNBEAM RD
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32257-8852
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-900-3340
Provider Business Mailing Address Fax Number:
904-900-3455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3948 SUNBEAM RD
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32257-8852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-900-3340
Provider Business Practice Location Address Fax Number:
904-900-3455
Provider Enumeration Date:
06/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHANGELA
Authorized Official First Name:
SUDHA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
904-900-3340

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0622617 , 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: R9519 . This is a "BC/BS OF FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 200065850 , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 005875100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 183626401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4841300 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001944100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1176613 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200538960 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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