1972629970 NPI number — MR. THOMAS JEFFREY RUFFNER SFIDC

Table of content: MR. THOMAS JEFFREY RUFFNER SFIDC (NPI 1972629970)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972629970 NPI number — MR. THOMAS JEFFREY RUFFNER SFIDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUFFNER
Provider First Name:
THOMAS
Provider Middle Name:
JEFFREY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
SFIDC
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:
1972629970
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7297 WIND CHASE DR
Provider Second Line Business Mailing Address:
NMCB 133 GULFPORT, MS
Provider Business Mailing Address City Name:
HAHIRA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31632-2299
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-506-1022
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5503 MARVIN SHIELDS BLVD
Provider Second Line Business Practice Location Address:
NHBC GULFPORT
Provider Business Practice Location Address City Name:
GULFPORT
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39501-9007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-871-2341
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/21/2007

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: 1710I1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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