1871686451 NPI number — PET SERVICES OF FLORIDA LLC

Table of content: (NPI 1871686451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871686451 NPI number — PET SERVICES OF FLORIDA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PET SERVICES OF FLORIDA 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:
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:
1871686451
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2463
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRYSTAL RIVER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34423-2463
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-795-9729
Provider Business Mailing Address Fax Number:
352-795-9262

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1541 SW 1ST AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34471-6532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-795-9729
Provider Business Practice Location Address Fax Number:
352-795-9262
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KAPPELL
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
352-795-9729

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  HCC6805 , 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: 008766300 . 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