1023287174 NPI number — NAPLES INJURY TREATMENT CENTER LLC

Table of content: (NPI 1023287174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023287174 NPI number — NAPLES INJURY TREATMENT CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NAPLES INJURY TREATMENT CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
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NPI Number Information

NPI Number:
1023287174
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4731 W ATLANTIC AVE
Provider Second Line Business Mailing Address:
SUITE B 21
Provider Business Mailing Address City Name:
DELRAY BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33445-3897
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
671 GOODLETTE RD N
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34102-5469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-643-7199
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SITNER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
RAY
Authorized Official Title or Position:
MGR
Authorized Official Telephone Number:
561-495-1212

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH8963 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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