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  7. NPI Record 1952772089

PUTNAM IMAGING CENTER, LLC
Complete NPI Record 1952772089
Urology in Palatka, FL

NPI Status: Active since October 15, 2015

Contact Information

6300 ST. JOHNS AVE.
PALATKA, FL
ZIP 32177
Phone: (386) 202-4006
Fax: (386) 385-5699

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Second Line Business Mailing Address
  7. Provider Business Mailing Address City Name
  8. Provider Business Mailing Address State Name
  9. Provider Business Mailing Address Postal Code
  10. Provider Business Mailing Address Country Code If outside U S
  11. Provider Business Mailing Address Telephone Number
  12. Provider Business Mailing Address Fax Number
  13. Provider First Line Business Practice Location Address
  14. Provider Business Practice Location Address City Name
  15. Provider Business Practice Location Address State Name
  16. Provider Business Practice Location Address Postal Code
  17. Provider Business Practice Location Address Country Code If outside U S
  18. Provider Business Practice Location Address Telephone Number
  19. Provider Business Practice Location Address Fax Number
  20. Provider Enumeration Date
  21. Last Update Date
  22. Authorized Official Last Name
  23. Authorized Official First Name
  24. Authorized Official Title or Position
  25. Authorized Official Telephone Number
  26. Healthcare Provider Taxonomy Code 1
  27. Provider License Number 1
  28. Provider License Number State Code 1
  29. Healthcare Provider Primary Taxonomy Switch 1
  30. Healthcare Provider Taxonomy Code 2
  31. Provider License Number 2
  32. Provider License Number State Code 2
  33. Healthcare Provider Primary Taxonomy Switch 2
  34. Healthcare Provider Taxonomy Code 3
  35. Provider License Number 3
  36. Provider License Number State Code 3
  37. Healthcare Provider Primary Taxonomy Switch 3
  38. Healthcare Provider Taxonomy Code 4
  39. Provider License Number 4
  40. Provider License Number State Code 4
  41. Healthcare Provider Primary Taxonomy Switch 4
  42. Healthcare Provider Taxonomy Code 5
  43. Provider License Number 5
  44. Provider License Number State Code 5
  45. Healthcare Provider Primary Taxonomy Switch 5
  46. Healthcare Provider Taxonomy Code 6
  47. Provider License Number 6
  48. Provider License Number State Code 6
  49. Healthcare Provider Primary Taxonomy Switch 6
  50. Healthcare Provider Taxonomy Code 7
  51. Provider License Number 7
  52. Provider License Number State Code 7
  53. Healthcare Provider Primary Taxonomy Switch 7
  54. Healthcare Provider Taxonomy Code 8
  55. Provider License Number 8
  56. Provider License Number State Code 8
  57. Healthcare Provider Primary Taxonomy Switch 8
  58. Is Organization Subpart
  59. Parent Organization LBN
  60. Parent Organization TIN
  61. Healthcare Provider Taxonomy Group 1
  62. Healthcare Provider Taxonomy Group 2
  63. Healthcare Provider Taxonomy Group 3
  64. Healthcare Provider Taxonomy Group 4
  65. Healthcare Provider Taxonomy Group 5
  66. Healthcare Provider Taxonomy Group 6
  67. Healthcare Provider Taxonomy Group 7
  68. Healthcare Provider Taxonomy Group 8

Complete NPI Dataset

This page represents the complete record for NPI 1952772089. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1952772089
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
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: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: 3426 NW 43RD ST
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Second Line Business Mailing Address: SUITE B
The second line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider second line location address’’.
Provider Business Mailing Address City Name: GAINESVILLE
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: FL
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 326068156
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 3523382089
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 3865302067
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 6300 ST. JOHNS 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: PALATKA
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: 321773884
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: 3862024006
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 3863855699
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 10/15/2015
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 11/20/2015
The date that a record was last updated or changed.
Authorized Official Last Name: NARAYAN
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: PERINCHERY
The first name of the authorized official.
Authorized Official Title or Position: PRESIDENT
The title or position of the authorized official.
Authorized Official Telephone Number: 3523382089
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 207P00000X
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: ME54477
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: N
Healthcare Provider Taxonomy Code 2: 207R00000X
Provider License Number 2: ME64833
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 2: 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 2: N
Healthcare Provider Taxonomy Code 3: 207RG0100X
Provider License Number 3: ME81873
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 3: 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 3: N
Healthcare Provider Taxonomy Code 4: 207RP1001X
Provider License Number 4: ME54534
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 4: 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 4: N
Healthcare Provider Taxonomy Code 5: 213ES0103X
Provider License Number 5: PO2829
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 5: 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 5: N
Healthcare Provider Taxonomy Code 6: 213ES0103X
Provider License Number 6: PO2712
Provider License Number State Code 6: FL
Healthcare Provider Primary Taxonomy Switch 6: N
Healthcare Provider Taxonomy Code 7: 213ES0103X
Provider License Number 7: PO2627
Provider License Number State Code 7: FL
Healthcare Provider Primary Taxonomy Switch 7: N
Healthcare Provider Taxonomy Code 8: 208800000X
Provider License Number 8: ME76357
Provider License Number State Code 8: FL
Healthcare Provider Primary Taxonomy Switch 8: Y
Is Organization Subpart: Y
Parent Organization LBN: PUTNAM PHYSICIANS GROUP, LLC
Parent Organization TIN: UNAVAIL
Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 2: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 3: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 4: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 5: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 6: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 7: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 8: 193200000X MULTI-SPECIALTY GROUP