1639276066 NPI number — ADVANCED PROSTHETICS OF AMERICA, INC.

Table of content: (NPI 1639276066)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639276066 NPI number — ADVANCED PROSTHETICS OF AMERICA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED PROSTHETICS OF AMERICA, INC.
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:
6
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:
1639276066
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 650846
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75265-0846
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-330-8881
Provider Business Mailing Address Fax Number:
800-261-9537

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2763 W OLD US HWY 441
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT DORA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32757-3500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-330-8881
Provider Business Practice Location Address Fax Number:
800-261-9537
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PRICE
Authorized Official First Name:
SHERYL
Authorized Official Middle Name:
S
Authorized Official Title or Position:
DIRECTOR OF REIMBURSEMENT
Authorized Official Telephone Number:
503-493-8288

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X , with the licence number: HCC4459 , 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: 000449600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1683602 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2331574 . This is a "AETNA HMO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: M2505 . This is a "BCBS FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 82-80128 . This is a "ACM" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 51086 . This is a "BCBS MI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 9107700300 . This is a "ACESS HEALTH SOLUTIONS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 008192 . This is a "FL HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 145048 . This is a "STAYWELL, WELLCARE, HEALT" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 51086 . This is a "ABP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 211935 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 50135 . This is a "FOUNDATION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 000006879 . This is a "BEECH STREET" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 276554 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 5688143 . This is a "AETNA PPO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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