1598737793 NPI number — MS. DOROTHY PETERS HITE MPAS, PA-C

Table of content: MS. DOROTHY PETERS HITE MPAS, PA-C (NPI 1598737793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598737793 NPI number — MS. DOROTHY PETERS HITE MPAS, PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HITE
Provider First Name:
DOROTHY
Provider Middle Name:
PETERS
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MPAS, PA-C
Provider Gender Code:
F

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:
1598737793
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
151 SOUTHHALL LN
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
MAITLAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32751-7172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-875-2080
Provider Business Mailing Address Fax Number:
407-650-3455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1503 BUENOS AIRES BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THE VILLAGES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32159-6821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-753-2812
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/02/2006

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: 363AM0700X , with the licence number:  PA9102050 , 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: 592660405 . This is a "GROUP TAX ID #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 10D0272724 . This is a "CLIA #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: CG7408 . This is a "RAILROAD M/C GROUP #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: K1373 . This is a "MEDICARE GROUP #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 970028747 . This is a "RAILROAD M/C PROVIDER #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 024583000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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