1871647008 NPI number — SINCLAIR SURGICAL PA

Table of content: (NPI 1871647008)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871647008 NPI number — SINCLAIR SURGICAL PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SINCLAIR SURGICAL 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:
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:
1871647008
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2507
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAVENPORT
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33836-2507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-421-4407
Provider Business Mailing Address Fax Number:
863-422-2888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
131 WEBB DRIVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
DAVENPORT
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33837-5905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-421-4407
Provider Business Practice Location Address Fax Number:
863-422-2888
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SINCLAIR
Authorized Official First Name:
KARLENE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
863-421-4407

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  ME88406 , 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: 195424 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7127058 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2684284 00 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 81652 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 012010500 . 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