NPI |
1255728325 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Entity Type Code |
2 |
The date that a record was last updated or changed. |
Employer Identification Number EIN |
|
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Provider Organization Name Legal Business Name |
AVERY PARTNERS, INC |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider Other Organization Name |
AVERY REHABILITATION |
Other name by which the organization provider is or has been known. |
Provider Other Organization Name Type Code |
3 |
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional
name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other. |
Provider First Line Business Practice Location Address |
236 NE 1ST AVE |
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 City Name |
HIGH SPRINGS |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
FL |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
326439443 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
|
Provider Business Practice Location Address Telephone Number |
3864540533 |
The telephone number associated with the location address of the provider being identified. |
Provider Enumeration Date |
4/16/2015 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
4/16/2015 |
The date that a record was last updated or changed. |
Authorized Official Last Name |
MOORE |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Authorized Official First Name |
JEFF |
The city name in the location address of the provider being identified. |
Authorized Official Title or Position |
CEO |
The title or position of the authorized official. |
Authorized Official Telephone Number |
7706395809 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
261QP2000X |
The telephone number associated with the location address of the provider being identified. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Organization Subpart |
N |
|
Authorized Official Name Prefix Text |
MR. |
|