1588675979 NPI number — AXCESS DIAGNOSTICS SARASOTA LLC

Table of content: (NPI 1588675979)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588675979 NPI number — AXCESS DIAGNOSTICS SARASOTA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AXCESS DIAGNOSTICS SARASOTA 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:
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:
1588675979
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 447
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VENICE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34284-0447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-488-5791
Provider Business Mailing Address Fax Number:
941-377-7975

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 NORTH CATTLEMEN ROAD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-342-0505
Provider Business Practice Location Address Fax Number:
941-487-5800
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MILEY
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
941-488-5791

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com