1831594514 NPI number — COOLEY GEORGE PANTAZIS, MD PA

Table of content: (NPI 1831594514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831594514 NPI number — COOLEY GEORGE PANTAZIS, MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COOLEY GEORGE PANTAZIS, MD PA
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:
1831594514
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 743170
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-3170
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-622-1378
Provider Business Mailing Address Fax Number:
352-622-3672

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 SW 1ST AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-351-7262
Provider Business Practice Location Address Fax Number:
352-402-5047
Provider Enumeration Date:
10/24/2014

Additional Information

Authorized Official

Authorized Official Last Name:
PANTAZIS
Authorized Official First Name:
COOLEY
Authorized Official Middle Name:
GEORGE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
352-208-7514

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  800000163 , 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: 013832900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com