1568450716 NPI number — MEDEX7, INC.

Table of content: (NPI 1568450716)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568450716 NPI number — MEDEX7, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDEX7, 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:
MED SERVICES NETWORK
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:
1568450716
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3238 S FLORIDA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKELAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33803-4551
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-680-1110
Provider Business Mailing Address Fax Number:
863-680-3364

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3238 S FLORIDA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKELAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33803-4551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-680-1110
Provider Business Practice Location Address Fax Number:
863-680-3364
Provider Enumeration Date:
10/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DI MOTTA
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
863-680-1110

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  640 , 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: 207578 . This is a "AMERIGROUP FLORIDA INC" identifier . This identifiers is of the category "OTHER".
  • Identifier: R8522 . This is a "BLUE CROSS PROVIDER NUMBE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: R8522 . This is a "BLUE CROSS FEDERAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 103133 . This is a "HEALTH PARTNERS HP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 292214 . This is a "BLUE CROSS PENNSYLVANIA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1523110 . This is a "UNITED MINEWORKERS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: Z45725 . This is a "BLUE CROSS MASSACHUSETTS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 050141300 . This is a "US DEPT LABOR/BLACK LUNG" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 951805300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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