Basic Information
| Provider Information | |||||||||
| NPI: | 1992257422 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TUBES 2 TABLES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1290 E NINE MILE RD STE B | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325141653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508579343 | ||||||||
| FaxNumber: | 8448487557 | ||||||||
| Practice Location | |||||||||
| Address1: | 1290 E NINE MILE RD STE B | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325141653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508579343 | ||||||||
| FaxNumber: | 8448487557 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2016 | ||||||||
| LastUpdateDate: | 06/19/2020 | ||||||||
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| AuthorizedOfficialLastName: | FERGUSON | ||||||||
| AuthorizedOfficialFirstName: | NEINA | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/ PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 8508579343 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PH.D., CCC-SLP | ||||||||
| NPICertificationDate: | 06/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 252Y00000X | N | Agencies | Early Intervention Provider Agency | 235Z00000X | SA6756 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 018856900 | 05 | FL | MEDICAID |