1942632260 NPI number — STACI APPLETON, MDPA

Table of content: (NPI 1942632260)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942632260 NPI number — STACI APPLETON, MDPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STACI APPLETON, MDPA
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:
APPLETON INTERNAL MEDICINE
Provider Other Organization Name Type Code:
3
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:
1942632260
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 278
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW SMYRNA BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32170-0278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-424-8440
Provider Business Mailing Address Fax Number:
386-426-8839

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
161 N CAUSEWAY
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
NEW SMYRNA BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32169-5303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-424-8440
Provider Business Practice Location Address Fax Number:
386-426-8839
Provider Enumeration Date:
08/09/2013

Additional Information

Authorized Official

Authorized Official Last Name:
LOUCKS
Authorized Official First Name:
HOLLIE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
386-424-8440

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME67829 , 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: 377693000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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