1053453415 NPI number — CYL MEDICAL CENTER INC.

Table of content: (NPI 1053453415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053453415 NPI number — CYL MEDICAL CENTER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CYL MEDICAL CENTER INC.
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:
1053453415
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1440 79TH STREET CSWY
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
NORTH BAY VILLAGE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33141-4188
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-866-5880
Provider Business Mailing Address Fax Number:
305-866-9441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1440 79TH STREET CSWY
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
NORTH BAY VILLAGE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33141-4188
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-866-5880
Provider Business Practice Location Address Fax Number:
305-866-9441
Provider Enumeration Date:
02/13/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CORRECHET
Authorized Official First Name:
CONSUELO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-866-5880

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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