1881972040 NPI number — ALLY MEDICAL SERVICES LLC

Table of content: (NPI 1881972040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881972040 NPI number — ALLY MEDICAL SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLY MEDICAL SERVICES 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:
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:
1881972040
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4951B E ADAMO DR
Provider Second Line Business Mailing Address:
SUITE 220
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33605-5924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-684-2507
Provider Business Mailing Address Fax Number:
866-695-2183

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4951B E ADAMO DR
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33605-5924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-684-2507
Provider Business Practice Location Address Fax Number:
866-695-2183
Provider Enumeration Date:
07/21/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CIANFROCCA
Authorized Official First Name:
TODD
Authorized Official Middle Name:
ELDER
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
813-785-8988

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1881972040 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1881972040 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0094174 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1881972040 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1881972040 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 96001038 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004438100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1881972040 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026392200 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4225571 00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100290040 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004438100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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