1952409963 NPI number — SOUTH FLORIDA SURGICAL SPECIALISTS LLC

Table of content: (NPI 1952409963)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952409963 NPI number — SOUTH FLORIDA SURGICAL SPECIALISTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH FLORIDA SURGICAL SPECIALISTS 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:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952409963
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3001 CORAL HILLS DR
Provider Second Line Business Mailing Address:
SUITE 320
Provider Business Mailing Address City Name:
CORAL SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33065-4172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-755-0111
Provider Business Mailing Address Fax Number:
954-755-2209

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3001 CORAL HILLS DR
Provider Second Line Business Practice Location Address:
SUITE 320
Provider Business Practice Location Address City Name:
CORAL SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33065-4172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-755-0111
Provider Business Practice Location Address Fax Number:
954-755-2209
Provider Enumeration Date:
09/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GULAREK
Authorized Official First Name:
JUSTIN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
954-755-0111

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00643 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 278013502 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 278013507 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 278013500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 278013503 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 278013504 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 278013505 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 278013506 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 278013501 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: DH1405 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com