1346239332 NPI number — FAMILY FOCUS INFUSION LLC

Table of content: (NPI 1346239332)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346239332 NPI number — FAMILY FOCUS INFUSION LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY FOCUS INFUSION 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:
1346239332
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4417 BEACH BLVD
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32207-4728
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-855-0040
Provider Business Mailing Address Fax Number:
904-855-0072

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4417 BEACH BLVD
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32207-4728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-855-0040
Provider Business Practice Location Address Fax Number:
904-855-0072
Provider Enumeration Date:
10/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SOPER
Authorized Official First Name:
DANA
Authorized Official Middle Name:
W
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
904-855-0040

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  PS 26357 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1835N1003X , with the licence number: PS 26357 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: PH 13657 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X , with the licence number: PH 13657 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336S0011X , with the licence number: PH 13657 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 103302601 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103302602 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103302600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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