1912490400 NPI number — ALBERTO ANDRES ARTEAGA USECHE

Table of content: ALBERTO ANDRES ARTEAGA USECHE (NPI 1912490400)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912490400 NPI number — ALBERTO ANDRES ARTEAGA USECHE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARTEAGA USECHE
Provider First Name:
ALBERTO
Provider Middle Name:
ANDRES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1912490400
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 NORTH STATE STREET
Provider Second Line Business Mailing Address:
UMMC, DEPARTMENT OF OTOLARYNGOLOGY - 5 EAST
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-815-3037
Provider Business Mailing Address Fax Number:
601-984-5085

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 SW ARCHER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32610-3003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-273-5199
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/11/2018

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: 390200000X , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X , with the licence number: ME160529 , 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: 118380500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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