1801980909 NPI number — ANDRES R VILLAR MD

Table of content: DR. MIROSLAV RAFAEL BRZOBOHATY DO (NPI 1407413636)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801980909 NPI number — ANDRES R VILLAR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANDRES R VILLAR MD
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:
6
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:
1801980909
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 606
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLEN ST MARY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32040-0606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-653-1818
Provider Business Mailing Address Fax Number:
904-653-1814

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14861 NW US HIGHWAY 441
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALACHUA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32615-8203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-462-1911
Provider Business Practice Location Address Fax Number:
386-462-1943
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VILLAR
Authorized Official First Name:
ANDRES
Authorized Official Middle Name:
R
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
386-755-5044

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 660174000 . This is a "MEDICAID RURAL HEALTH CLINIC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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