NPI |
1598980690 |
|
Entity Type Code |
2 |
The country code in the location address of the provider being identified. |
Employer Identification Number EIN |
|
The fax number associated with the location
address of the provider being identified. |
Provider Organization Name Legal Business Name |
TCORP INC |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Other Organization Name |
TCORP SURGICAL INC |
Other name by which the organization provider is or has been known. |
Provider Other Organization Name Type Code |
3 |
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 First Line Business Practice Location Address |
2013 E JEFFERSON STREET |
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 |
ORLANDO |
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 |
32803 |
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 |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
3212066308 |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Fax Number |
4075745715 |
The fax number associated with the location
address of the provider being identified. |
Provider Enumeration Date |
4/16/2007 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
8/22/2020 |
The first name of the provider, if the provider
is an individual. |
Authorized Official Last Name |
DRABICK |
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 |
TIMOTHY |
The first name of the authorized official. |
Authorized Official Middle Name |
EDWARD |
The middle name of the authorized official. |
Authorized Official Title or Position |
PRESIDENT ADMINISTRATOR |
The title or position of the authorized official. |
Authorized Official Telephone Number |
3212066308 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
261QA1903X |
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 Primary Taxonomy Switch 1 |
Y |
|
Is Organization Subpart |
N |
|
Authorized Official Name Prefix Text |
MR. |
|