1700145802 NPI number — COYT ANDREW ROUNTREE M.D.

Table of content: COYT ANDREW ROUNTREE M.D. (NPI 1700145802)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700145802 NPI number — COYT ANDREW ROUNTREE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROUNTREE
Provider First Name:
COYT
Provider Middle Name:
ANDREW
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1700145802
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4724 N DAVIS HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENSACOLA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32503-2339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-696-4000
Provider Business Mailing Address Fax Number:
850-607-7317

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4724 N DAVIS HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENSACOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-696-4000
Provider Business Practice Location Address Fax Number:
850-607-7317
Provider Enumeration Date:
05/09/2012

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: 2085R0001X , with the licence number:  ME135930 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 390200000X . This is a "STUDENT IN AN ORGANIZED HEALTH CARE EDUCATION/TRAINING PROGRAM" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 024591300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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