1750457289 NPI number — MRS. DIANE GAIL ALTHER MSW LCSW RN

Table of content: V MATTI VEHASKARI MD (NPI 1649293614)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750457289 NPI number — MRS. DIANE GAIL ALTHER MSW LCSW RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALTHER
Provider First Name:
DIANE
Provider Middle Name:
GAIL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW LCSW RN
Provider Gender Code:
F

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:
1750457289
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1296
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUNNELLON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-425-1992
Provider Business Mailing Address Fax Number:
352-465-2118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 N MAGNOLIA AVE
Provider Second Line Business Practice Location Address:
SUITE 505
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34475
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-425-1992
Provider Business Practice Location Address Fax Number:
352-465-2118
Provider Enumeration Date:
11/27/2006

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: 1041C0700X , with the licence number:  SW7901 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1041C0700X , with the licence number: R040798 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 163W00000X , with the licence number: 2325091 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 163W00000X , with the licence number: RN9254860 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 299205 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2089E . This is a "BC BSF" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7480250 . This is a "GHI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 056612 . This is a "VALUE OPTIONS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 11545795 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 9285642 . This is a "PHCS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 203795 . This is a "MHN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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