1356575674 NPI number — THSE - SOUTH FLORIDA MC LLC

Table of content: (NPI 1356575674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356575674 NPI number — THSE - SOUTH FLORIDA MC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THSE - SOUTH FLORIDA MC 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:
INPHYNET CONTRACTING SERVICES INC
Provider Other Organization Name Type Code:
3
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:
1356575674
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14050 NW 14TH ST
Provider Second Line Business Mailing Address:
SUITE 190
Provider Business Mailing Address City Name:
SUNRISE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33323-2865
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-424-3672
Provider Business Mailing Address Fax Number:
954-377-3042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 N ALEXANDER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLANT CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33563-4303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-757-1200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HOLTZCLAW
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
800-424-3672

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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