1851592075 NPI number — DR. WILLIAM S CANTWELL MD

Table of content: DR. WILLIAM S CANTWELL MD (NPI 1851592075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851592075 NPI number — DR. WILLIAM S CANTWELL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CANTWELL
Provider First Name:
WILLIAM
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
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:
1851592075
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18167 US HIGHWAY 19 N
Provider Second Line Business Mailing Address:
SUITE 650
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33764-3528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-533-8707
Provider Business Mailing Address Fax Number:
727-507-3618

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
211 4TH ST
Provider Second Line Business Practice Location Address:
EMCARE
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71301-8421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-533-8707
Provider Business Practice Location Address Fax Number:
727-507-3618
Provider Enumeration Date:
05/29/2007

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: 207R00000X , with the licence number:  MD.201136 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0200X , with the licence number: MD.201136 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0200X , with the licence number: N3533 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 208430301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 208430302 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: TIN PLUS 042 . This is a "TRICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8V3851 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 181274001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1092819 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09281 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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