1649475278 NPI number — ALLISON V MENEZES MD PLLC

Table of content: (NPI 1649475278)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649475278 NPI number — ALLISON V MENEZES MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLISON V MENEZES MD 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:
1649475278
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4855 FEATHERBED LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SARASOTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34242-1558
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-921-6161
Provider Business Mailing Address Fax Number:
866-456-4659

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6040 53RD AVE E UNIT A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRADENTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34203-9720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-921-6161
Provider Business Practice Location Address Fax Number:
866-456-4659
Provider Enumeration Date:
06/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MENEZES
Authorized Official First Name:
ALLISON
Authorized Official Middle Name:
VIRGINIA
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
941-921-6161

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  ME65322 , 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: DF8545 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: AD135 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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