1003103276 NPI number — SOUTH FLORIDA SURGERY AND HAND CARE LLC

Table of content: (NPI 1003103276)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003103276 NPI number — SOUTH FLORIDA SURGERY AND HAND CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH FLORIDA SURGERY AND HAND CARE 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:
AVENTURA HAND CENTER
Provider Other Organization Name Type Code:
5
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:
1003103276
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20895 E DIXIE HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AVENTURA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33180-1427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-519-4263
Provider Business Mailing Address Fax Number:
305-454-9390

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20895 E DIXIE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVENTURA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33180-1427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-519-4263
Provider Business Practice Location Address Fax Number:
786-228-4040
Provider Enumeration Date:
07/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ZULOAGA
Authorized Official First Name:
OLGA
Authorized Official Middle Name:
LIDIA
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
786-519-4263

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  ME 110115 , 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)

  • Identifier: 3376055 . This is a "UNITED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1087938 . This is a "CAREPLUS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 634037 . This is a "HARMONY/STAYWELL/WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 004465700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1415 . This is a "POSITIVE HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 349608 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 58569 . This is a "HEALTHSUN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: QSEGW . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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