1124057864 NPI number — TREASURE COAST OB GYN ASSOCIATES P A

Table of content: (NPI 1124057864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124057864 NPI number — TREASURE COAST OB GYN ASSOCIATES P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TREASURE COAST OB GYN ASSOCIATES P A
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:
6
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:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124057864
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3498 NW FEDERAL HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JENSEN BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34957-4441
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-219-1080
Provider Business Mailing Address Fax Number:
772-219-1070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3498 NW FEDERAL HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JENSEN BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34957-4441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-219-1080
Provider Business Practice Location Address Fax Number:
772-219-1070
Provider Enumeration Date:
07/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PARE
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
722-219-1080

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com