1740261189 NPI number — ST JOSEPH'S SAME DAY SURGERY

Table of content: (NPI 1740261189)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740261189 NPI number — ST JOSEPH'S SAME DAY SURGERY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST JOSEPH'S SAME DAY SURGERY
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:
ST JOSEPH'S SAME DAY SURGERY,LTD
Provider Other Organization Name Type Code:
3
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:
1740261189
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P O BOX 403910
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-852-3272
Provider Business Mailing Address Fax Number:
813-852-3233

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3003 W DR MLK JR BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33607-6307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-870-4711
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
INZINA
Authorized Official First Name:
TOMMY
Authorized Official Middle Name:
Authorized Official Title or Position:
SR VP CFO BCHS
Authorized Official Telephone Number:
727-820-8004

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 62705400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 653 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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