1144274317 NPI number — PLANTATION GENERAL HOSPITAL L P

Table of content: CLIFF J WHIGHAM JR. D.O. (NPI 1487644910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144274317 NPI number — PLANTATION GENERAL HOSPITAL L P

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLANTATION GENERAL HOSPITAL L P
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:
1144274317
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 NW 42ND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANTATION
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33317-2835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-587-5010
Provider Business Mailing Address Fax Number:
954-587-3220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 NW 42ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLANTATION
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33317-2835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-587-5010
Provider Business Practice Location Address Fax Number:
954-587-3220
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HUGHES
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
954-513-6000

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 531468000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000037939 . This is a "HUMANA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 012000600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0159388 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20909 . This is a "WELLCARE/STAYWELL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 14963 . This is a "AMERIGROUP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 258 . This is a "BLUE CROSS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0960081 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 412145 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0784897 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 012000600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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