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  7. NPI Record 1750644811

NORTHSIDE BEHAVIORAL HEALTH CENTER INC
Complete NPI Record 1750644811
Case Management in Tampa, FL

NPI Status: Active since June 22, 2012

Contact Information

12512 BRUCE B DOWNS BLVD
TAMPA, FL
ZIP 33612
Phone: (813) 977-8700
Fax: (813) 971-2029

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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 Other Organization Name
  6. Provider Other Organization Name Type Code
  7. Provider First Line Business Mailing Address
  8. Provider Business Mailing Address City Name
  9. Provider Business Mailing Address State Name
  10. Provider Business Mailing Address Postal Code
  11. Provider Business Mailing Address Country Code If outside U S
  12. Provider Business Mailing Address Telephone Number
  13. Provider Business Mailing Address Fax Number
  14. Provider First Line Business Practice Location Address
  15. Provider Business Practice Location Address City Name
  16. Provider Business Practice Location Address State Name
  17. Provider Business Practice Location Address Postal Code
  18. Provider Business Practice Location Address Country Code If outside U S
  19. Provider Business Practice Location Address Telephone Number
  20. Provider Business Practice Location Address Fax Number
  21. Provider Enumeration Date
  22. Last Update Date
  23. Authorized Official Last Name
  24. Authorized Official First Name
  25. Authorized Official Title or Position
  26. Authorized Official Telephone Number
  27. Healthcare Provider Taxonomy Code 1
  28. Healthcare Provider Primary Taxonomy Switch 1
  29. Other Provider Identifier 1
  30. Other Provider Identifier Type Code 1
  31. Other Provider Identifier State 1
  32. Is Organization Subpart
  33. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1750644811. 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: 1750644811
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Entity Type Code: 2
The city name in the mailing address of the provider being identified.
Employer Identification Number EIN: UNAVAIL
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’’.
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 Other Organization Name: NORTHSIDE BEHAVIORAL HEALTH CENTER INC
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 Other Organization Name Type Code: 5
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 First Line Business Mailing Address: 2995 DREW ST FL 2
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 Business Mailing Address City Name: CLEARWATER
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 Mailing Address State Name: FL
The city name in the location address of the provider being identified.
Provider Business Mailing Address Postal Code: 337593012
The State code in the location of the provider being identified.
Provider Business Mailing Address Country Code If outside U S : US
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 Mailing Address Telephone Number: 7273156974
The country code in the location address of the provider being identified.
Provider Business Mailing Address Fax Number: 8136352613
The telephone number associated with the location address of the provider being identified.
Provider First Line Business Practice Location Address: 12512 BRUCE B DOWNS BLVD
The fax number associated with the location address of the provider being identified.
Provider Business Practice Location Address City Name: TAMPA
The date the provider was assigned a unique identifier (assigned an NPI).
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: 336129209
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: 8139778700
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 8139712029
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 6/22/2012
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 8/1/2023
The date that a record was last updated or changed.
Authorized Official Last Name: GORKEN
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: LYNDA
The first name of the authorized official.
Authorized Official Title or Position: VICE PRESIDENT
Authorized Official Telephone Number: 7272819202
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
Healthcare Provider Taxonomy Code 1: 251B00000X
Healthcare Provider Primary Taxonomy Switch 1: Y
Other Provider Identifier 1: 117580100
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: 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 1: FL
Is Organization Subpart: N
NPI Certification Date: 8/1/2023