1730103086 NPI number — ATLANTIC SPACE COAST GI PA

Table of content: DR. KARIN JOHANNA MARIA MCCOY PH.D. (NPI 1790877728)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730103086 NPI number — ATLANTIC SPACE COAST GI PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATLANTIC SPACE COAST GI PA
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:
1730103086
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:
1009 HARVIN WAY
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
ROCKLEDGE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32955
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-632-0497
Provider Business Mailing Address Fax Number:
321-631-7746

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1009 HARVIN WAY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
ROCKLEDGE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-632-0497
Provider Business Practice Location Address Fax Number:
321-631-7746
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TOBKES
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
321-632-0497

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  ME0060192 , 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)





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