1932323839 NPI number — KOZAK P T & ASSOC INC

Table of content: (NPI 1932323839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932323839 NPI number — KOZAK P T & ASSOC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KOZAK P T & ASSOC INC
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:
1932323839
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10099 SEMINOLE BLVD
Provider Second Line Business Mailing Address:
SUITE 5A
Provider Business Mailing Address City Name:
SEMINOLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33772-2521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-399-8226
Provider Business Mailing Address Fax Number:
727-393-4823

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10099 SEMINOLE BLVD
Provider Second Line Business Practice Location Address:
SUITE 5A
Provider Business Practice Location Address City Name:
SEMINOLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33772-2521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-399-8226
Provider Business Practice Location Address Fax Number:
727-393-4823
Provider Enumeration Date:
04/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KOZAK
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
ANDREW
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
727-399-8226

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  PT 3271 , 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: R5H . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 5288337 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 890763300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: Y4593 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 360474900 . This is a "ACS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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