=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851711196
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANDREWS RESEARCH AND EDUCATION INSTITUTE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2014
-----------------------------------------------------
Last Update Date | 04/25/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1020 GULF BREEZE PKWY
-----------------------------------------------------
City | GULF BREEZE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32561-4838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-916-8702
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1020 GULF BREEZE PKWY
-----------------------------------------------------
City | GULF BREEZE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32561-4838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-916-8702
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/MEDICAL DIRECTOR
-----------------------------------------------------
Name | JAMES R ANDREWS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 850-916-8774
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number | AL 785
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------