1649268137 NPI number — DR. EILEEN F FARWICK DO

Table of content: DR. EILEEN F FARWICK DO (NPI 1649268137)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649268137 NPI number — DR. EILEEN F FARWICK DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARWICK
Provider First Name:
EILEEN
Provider Middle Name:
F
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1649268137
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10000 W COLONIAL DR
Provider Second Line Business Mailing Address:
STE 386
Provider Business Mailing Address City Name:
OCOEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34761-3498
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-296-1990
Provider Business Mailing Address Fax Number:
407-296-1992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10000 W COLONIAL DR
Provider Second Line Business Practice Location Address:
SUITE 386
Provider Business Practice Location Address City Name:
OCOEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34761-3498
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-296-1990
Provider Business Practice Location Address Fax Number:
407-296-1992
Provider Enumeration Date:
10/10/2005

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: 207V00000X , with the licence number:  OSO005926 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VG0400X , with the licence number: OS0005926 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VF0040X , with the licence number: OS-5926 , 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: 266246900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4549601 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 80913 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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