1609849231 NPI number — RA MUSELLA MD FACS PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609849231 NPI number — RA MUSELLA MD FACS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RA MUSELLA MD FACS 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:
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:
1609849231
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
10/31/2012
NPI Reactivation Date:
05/21/2013

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6600 66TH ST N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PINELLAS PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33781
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-638-1853
Provider Business Mailing Address Fax Number:
239-790-5050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6600 66TH ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINELLAS PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33781
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-638-1853
Provider Business Practice Location Address Fax Number:
239-790-5050
Provider Enumeration Date:
02/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHARLAND
Authorized Official First Name:
MARCI
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING SUPERVISOR
Authorized Official Telephone Number:
231-638-1853

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  ME0018297 , 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: 047952700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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