1174780589 NPI number — YOUR CARE CLINICS LLC

Table of content: (NPI 1174780589)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174780589 NPI number — YOUR CARE CLINICS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YOUR CARE CLINICS 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:
1174780589
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10225 ULMERTON RD STE 9A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARGO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33771-3526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-588-7665
Provider Business Mailing Address Fax Number:
727-230-9194

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10225 ULMERTON RD
Provider Second Line Business Practice Location Address:
SUITE 9A
Provider Business Practice Location Address City Name:
LARGO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33771-3538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-588-7600
Provider Business Practice Location Address Fax Number:
727-230-9194
Provider Enumeration Date:
05/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
FRIEDRICH
Authorized Official First Name:
PHYLLIS
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
727-588-7665

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , 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: 2523919 . This is a "AETNA-HMO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 6806670 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 277731201 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: J804 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 54473357 . This is a "COLORADO MEDICAID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 39469 . This is a "BLUE CROSS BLUE SHIELD OF FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7566598 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com