1528187812 NPI number — PRO-ECHO INC

Table of content: (NPI 1528187812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528187812 NPI number — PRO-ECHO INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRO-ECHO 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:
PRO-ECHO DIAGNOSTICS
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:
1528187812
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 546436
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SURFSIDE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33154-0436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-532-7460
Provider Business Mailing Address Fax Number:
305-532-7648

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
907 ALTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33139-5203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-673-4247
Provider Business Practice Location Address Fax Number:
305-532-7648
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EBER
Authorized Official First Name:
DARYL
Authorized Official Middle Name:
JEROME
Authorized Official Title or Position:
OWNER / MEDICAL DIRECTOR
Authorized Official Telephone Number:
305-532-7460

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X , with the licence number:  HCC12014 , 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: 000863000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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