1750339230 NPI number — ERICH A ARIAS MD

Table of content: ERICH A ARIAS MD (NPI 1750339230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750339230 NPI number — ERICH A ARIAS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARIAS
Provider First Name:
ERICH
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1750339230
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 FLORIDA AVE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKLEDGE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32955-2482
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-549-2273
Provider Business Mailing Address Fax Number:
321-549-2066

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 FLORIDA AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKLEDGE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32955-2482
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-549-2273
Provider Business Practice Location Address Fax Number:
321-549-2066
Provider Enumeration Date:
05/05/2006

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: 207Q00000X , with the licence number:  MD 426791 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 18796 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: ME101986 , 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: 002887100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7164742 . This is a "AETNA" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 5097721 . This is a "CIGNA" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 6029049 . This is a "HEALTHSPRING" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: P00816371 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 01079820 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1020761 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002887100 . 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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