1942224696 NPI number — SVMC HOLDINGS, INC

Table of content: (NPI 1942224696)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942224696 NPI number — SVMC HOLDINGS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SVMC HOLDINGS, 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:
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:
1942224696
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2800 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIDGEPORT
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06606-4201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-576-5551
Provider Business Mailing Address Fax Number:
206-576-5345

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06606-4201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-576-5551
Provider Business Practice Location Address Fax Number:
206-576-5345
Provider Enumeration Date:
07/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SLYWKA
Authorized Official First Name:
ROSEANN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF PT. FINANCIAL SERVICES
Authorized Official Telephone Number:
475-210-5291

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  0057 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 004041893 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004025185 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 115949800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".