1619591864 NPI number — TODAY TELEMEDICINE PLLC

Table of content: (NPI 1619591864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619591864 NPI number — TODAY TELEMEDICINE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TODAY TELEMEDICINE PLLC
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:
1619591864
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 VILLAGE SQUARE BLVD # 3-81835
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TALLAHASSEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32312-1250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-902-8899
Provider Business Mailing Address Fax Number:
800-964-0791

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31331 SHADOW BRANCH LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77386-4611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-902-8899
Provider Business Practice Location Address Fax Number:
800-964-0791
Provider Enumeration Date:
06/03/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PURDY
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PHYSICIAN ASSISTANT
Authorized Official Telephone Number:
407-902-8899

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1487739512 . This is a "COMMERCIAL GROUP PLANS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 114161500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".