1821357708 NPI number — NANCY E. DAVIE, INC.

Table of content: (NPI 1821357708)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821357708 NPI number — NANCY E. DAVIE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NANCY E. DAVIE, INC.
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:
1821357708
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 748
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACCLENNY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32063-0748
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-259-1758
Provider Business Mailing Address Fax Number:
904-259-9553

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 S 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MACCLENNY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32063-2303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-259-1758
Provider Business Practice Location Address Fax Number:
904-259-9553
Provider Enumeration Date:
05/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIE
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
904-259-1758

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  MH3067 , 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: 11530833 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 133518000 . This is a "MAGELLAN HEALTH SERVICES" identifier . This identifiers is of the category "OTHER".
  • Identifier: Z6736 . This is a "BC/BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100055819 . This is a "SOUTHCARE PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 239885 . This is a "AV-MED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 169263 . This is a "MANAGED HN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 272031 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2016499 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5378011 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9426111 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: DAVNANCY . This is a "CORPHEALTH, INC." identifier . This identifiers is of the category "OTHER".




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