1629079520 NPI number — DR. SARA ANN BOHN D.O.

Table of content: DR. SARA ANN BOHN D.O. (NPI 1629079520)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629079520 NPI number — DR. SARA ANN BOHN D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOHN
Provider First Name:
SARA
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1629079520
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/22/2006
NPI Reactivation Date:
03/30/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
423 PALASTRO AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUBURNDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33823-8704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-353-8008
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 ARNESON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURNDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33823-3229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-393-6404
Provider Business Practice Location Address Fax Number:
863-583-3118
Provider Enumeration Date:
08/02/2005

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: 173000000X , with the licence number:  36976 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 36976 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: OS13725 , 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: 0104183 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 080183733 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 242866655 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 16644 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 4251694 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 194082 . This is a "HEALTH LINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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