1700843513 NPI number — SOUTHEASTERN INTERVENTIONAL PAIN PHYSICIANS, P.A.

Table of content: WILLIAM ANTHONY MAY MD (NPI 1790884898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700843513 NPI number — SOUTHEASTERN INTERVENTIONAL PAIN PHYSICIANS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHEASTERN INTERVENTIONAL PAIN PHYSICIANS, P.A.
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:
1700843513
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:
PO BOX 699
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GULF BREEZE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32562-0699
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-243-7788
Provider Business Mailing Address Fax Number:
850-243-7738

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
151 MARY ESTHER BLVD
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
MARY ESTHER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32569-1972
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-243-7788
Provider Business Practice Location Address Fax Number:
850-243-7738
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NEWSOM
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL BILLER
Authorized Official Telephone Number:
850-243-7788

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 45117 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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