1790866242 NPI number — TIMOTHY J CAHILL MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790866242 NPI number — TIMOTHY J CAHILL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAHILL
Provider First Name:
TIMOTHY
Provider Middle Name:
J
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:
1790866242
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8761 PERIMETER PARK BLVD
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32216-1106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-641-6628
Provider Business Mailing Address Fax Number:
904-642-1243

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2626 CAPITAL MEDICAL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TALLAHASSEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32308-4402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-641-6628
Provider Business Practice Location Address Fax Number:
904-642-1243
Provider Enumeration Date:
10/18/2006

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: 207P00000X , with the licence number:  200400825 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207P00000X , with the licence number: ME97443 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 278244800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: ME0097443 . This is a "STATE OF FLORIDA WORKERS COMP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 95655 . This is a "FLORIDA BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com