1760485940 NPI number — FIRST RESPONSE MEDICAL CORP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760485940 NPI number — FIRST RESPONSE MEDICAL CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST RESPONSE MEDICAL CORP
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:
1760485940
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10240 SW 56TH ST
Provider Second Line Business Mailing Address:
STE 112C
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33165-7070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-412-9393
Provider Business Mailing Address Fax Number:
305-412-9394

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10240 SW 56TH ST
Provider Second Line Business Practice Location Address:
STE 112C
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33165-7070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-412-9393
Provider Business Practice Location Address Fax Number:
305-412-9394
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALEZ
Authorized Official First Name:
MARISSA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
305-412-9393

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  01875 , 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: 211769 . This is a "AMERIGROUP PROVIDER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: R8891 . This is a "BLUE CROSS PROVIDER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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