1356656813 NPI number — ABSOLUTE MEDICAL SERVICES, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356656813 NPI number — ABSOLUTE MEDICAL SERVICES, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABSOLUTE MEDICAL SERVICES, PA
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:
1356656813
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
521 SE FORT ISLAND TRAIL, SUITE E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRYSTAL RIVER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34429-8904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-563-5858
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
521 SE FORT ISLAND TRL
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
CRYSTAL RIVER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34429-8904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-563-5858
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/09/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BACCHUS
Authorized Official First Name:
SUNITA
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
352-854-5530

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  OS0004310 , 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)





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