1932449451 NPI number — GACEK EAR AND SINUS CENTER LLC

Table of content: (NPI 1932449451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932449451 NPI number — GACEK EAR AND SINUS CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GACEK EAR AND SINUS CENTER 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:
1932449451
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4721 MORRISON DR STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36609-3350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-340-6947
Provider Business Mailing Address Fax Number:
251-460-5457

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 HILLCREST RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36695-3904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-340-7970
Provider Business Practice Location Address Fax Number:
251-340-7971
Provider Enumeration Date:
02/20/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GACEK
Authorized Official First Name:
MARK
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
251-340-7970

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  0002170 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 147898 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com