1477997013 NPI number — USA WELLNESS PROVIDERS CORP

Table of content: (NPI 1477997013)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477997013 NPI number — USA WELLNESS PROVIDERS CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
USA WELLNESS PROVIDERS CORP
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:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477997013
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1050 LEE WAGENER BLVD
Provider Second Line Business Mailing Address:
230
Provider Business Mailing Address City Name:
FORT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33315-3500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-683-2223
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1050 LEE WAGENER BLVD
Provider Second Line Business Practice Location Address:
230
Provider Business Practice Location Address City Name:
FORT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33315-3500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-683-2223
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/25/2013

Additional Information

Authorized Official

Authorized Official Last Name:
CORREA
Authorized Official First Name:
ANGELO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
678-683-2223

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)

  • Identifier: GZ379A . This is a "MEDICARE PART B" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com