1316923147 NPI number — DR. JEFFREY BRETT SACK MD FACC FACA FCCP

Table of content: DR. JEFFREY BRETT SACK MD FACC FACA FCCP (NPI 1316923147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316923147 NPI number — DR. JEFFREY BRETT SACK MD FACC FACA FCCP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SACK
Provider First Name:
JEFFREY
Provider Middle Name:
BRETT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD FACC FACA FCCP
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:
1316923147
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 15157
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SARASOTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34277-1157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-371-3800
Provider Business Mailing Address Fax Number:
941-371-2069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5471 BEE RIDGE RD
Provider Second Line Business Practice Location Address:
SUITE 260
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-371-3800
Provider Business Practice Location Address Fax Number:
941-371-2069
Provider Enumeration Date:
12/22/2005

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: 207RI0011X , with the licence number:  ME0056807 , 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: 259834500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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