1790747020 NPI number — JAMES A. HALEY VA HOSPITAL

Table of content: THIEN AN MAI HOANG MD (NPI 1891547204)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790747020 NPI number — JAMES A. HALEY VA HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES A. HALEY VA HOSPITAL
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:
1790747020
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34404 COUNTRYSIDE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ZEPHYRHILLS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33543-5228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-715-0999
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13000 BRUCE B DOWNS BLVD
Provider Second Line Business Practice Location Address:
NURSING 118-A
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33612-4745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-972-2000
Provider Business Practice Location Address Fax Number:
813-978-5933
Provider Enumeration Date:
04/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CUTOLO
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
P
Authorized Official Title or Position:
CHEIF OF STAFF
Authorized Official Telephone Number:
813-972-2000

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  RN9212853 , 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)