1639289036 NPI number — PRINCETON PROFESSIONAL SERVICES

Table of content: (NPI 1639289036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639289036 NPI number — PRINCETON PROFESSIONAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRINCETON PROFESSIONAL SERVICES
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:
1639289036
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 COURTLAND ST
Provider Second Line Business Mailing Address:
# 300
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32804-1332
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-691-8200
Provider Business Mailing Address Fax Number:
407-691-8222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 COURTLAND ST
Provider Second Line Business Practice Location Address:
# 300
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32804-1332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-691-8200
Provider Business Practice Location Address Fax Number:
407-691-8222
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STILTZ
Authorized Official First Name:
BRYAN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOROFFICER
Authorized Official Telephone Number:
407-691-8200

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  20383096 , 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: 107211 . This is a "UNISON HEALTH PLAN MCR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 107211 . This is a "EVERCARE MCR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 107211 . This is a "HUMANA GOLD CHC MCR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 107211 . This is a "PACIFICARE MCR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: H56 . This is a "BLUE CROSS BLUE SHIELD OF" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: HIGHMARK BCBS MCR . This is a "107211" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 107211 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 107211 . This is a "WELLCARE MCR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: AMERIGROUP . This is a "115555" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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