NPI |
1760541213 |
The first name of the provider, if the provider
is an individual. |
Entity Type Code |
2 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Employer Identification Number EIN |
|
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Provider Organization Name Legal Business Name |
NORTH FLORIDA MEDICAL SALES AND RENTALS OF GAINESVILLE, INC. |
The country code in the location address of the provider being identified. |
Provider First Line Business Practice Location Address |
3558 NW 97TH BLVD |
The fax number associated with the location
address of the provider being identified. |
Provider Business Practice Location Address City Name |
GAINESVILLE |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
FL |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider Business Practice Location Address Postal Code |
326067323 |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
3523318088 |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Fax Number |
3523318087 |
|
Provider Enumeration Date |
12/8/2006 |
The country code in the location address of the provider being identified. |
Last Update Date |
2/27/2019 |
The telephone number associated with the location address of the provider being identified. |
Authorized Official Last Name |
RUSSELL |
The fax number associated with the location
address of the provider being identified. |
Authorized Official First Name |
SID |
The date the provider was assigned a unique identifier (assigned an NPI). |
Authorized Official Middle Name |
DUANE |
The middle name of the authorized official. |
Authorized Official Title or Position |
VP |
The title or position of the authorized official. |
Authorized Official Telephone Number |
3523318088 |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Healthcare Provider Taxonomy Code 1 |
332BX2000X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider License Number 1 |
1312941 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider License Number State Code 1 |
FL |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Other Provider Identifier 1 |
R9835 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
Other Provider Identifier Type Code 1 |
01 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
Other Provider Identifier State 1 |
FL |
|
Other Provider Identifier Issuer 1 |
BLUE CROSS BLUE SHIELD |
|
Other Provider Identifier 2 |
0313050 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
Other Provider Identifier Type Code 2 |
05 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
Other Provider Identifier State 2 |
FL |
|
Is Organization Subpart |
N |
|