1740618875 NPI number — ISLAND DOCTORS OF NEW SMYRNA BEACH MEDICAL CENTER LLC

Table of content: (NPI 1740618875)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740618875 NPI number — ISLAND DOCTORS OF NEW SMYRNA BEACH MEDICAL CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ISLAND DOCTORS OF NEW SMYRNA BEACH MEDICAL CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
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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:
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NPI Number Information

NPI Number:
1740618875
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4960 SW 72ND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33155-5544
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-662-5200
Provider Business Mailing Address Fax Number:
305-284-7913

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
406 PALMETTO ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
NEW SMYRNA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32168-7323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-423-1212
Provider Business Practice Location Address Fax Number:
386-423-5730
Provider Enumeration Date:
10/29/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ARMAS
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-662-5200

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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