1942285390 NPI number — GEORGIS PATSIAS MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942285390 NPI number — GEORGIS PATSIAS MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

PATSIAS

Provider First Name:

GEORGIS

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1942285390

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/28/2017

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

2234 COLONIAL BLVD

Provider Second Line Business Mailing Address:

ATTN: PAYER CONTRACTING & RELATIONS DEPT.

Provider Business Mailing Address City Name:

FORT MYERS

Provider Business Mailing Address State Name:

FL

Provider Business Mailing Address Postal Code:

33907-1412

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

239-931-7342

Provider Business Mailing Address Fax Number:

239-931-7385

Provider First Line Business Practice Location Address:

3347 STATE ROAD 7

Provider Second Line Business Practice Location Address:

SUITE 101

Provider Business Practice Location Address City Name:

WELLINGTON

Provider Business Practice Location Address State Name:

FL

Provider Business Practice Location Address Postal Code:

33449-8095

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

561-790-2111

Provider Business Practice Location Address Fax Number:

561-790-0348

Provider Enumeration Date:

12/08/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208800000X , with the licence number:  ME0049282 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 373720900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
• Identifier: P01596409 . This is a "RR MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: P102736 . This is a "OPTIMUN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: P107179 . This is a "FREEDOM" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 1249251 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 18997 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 3615094 . This is a "KEYS PHA - CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 1004500 . This is a "CAREPLUS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 4311 . This is a "DIMENSIONS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 5500033 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 008661200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".