1861814022 NPI number — OGLETHORPE OF ST CLOUD LLC

Table of content: (NPI 1861814022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861814022 NPI number — OGLETHORPE OF ST CLOUD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OGLETHORPE OF ST CLOUD LLC
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:
HEROES MILE
Provider Other Organization Name Type Code:
3
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:
1861814022
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7074 GROVE RD STE 129
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING HILL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34609-8658
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-597-5075
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2775 BIG JOHN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32724-4000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-337-7957
Provider Business Practice Location Address Fax Number:
386-337-7968
Provider Enumeration Date:
01/07/2014

Additional Information

Authorized Official

Authorized Official Last Name:
OGDEN
Authorized Official First Name:
ANNINE
Authorized Official Middle Name:
HELEN
Authorized Official Title or Position:
STAFF ACCOUNTANT
Authorized Official Telephone Number:
813-978-1933

Provider Taxonomy Codes

  • Taxonomy code: 323P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , with the licence number: 0949AD581501 , 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)





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