1013097567 NPI number — MIAMI FIRST ASSIST, LLC

Table of content: (NPI 1013097567)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013097567 NPI number — MIAMI FIRST ASSIST, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIAMI FIRST ASSIST, LLC
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:
1013097567
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
214 CENTERVIEW DRIVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-345-5450
Provider Business Mailing Address Fax Number:
615-345-5365

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 SARNO ROAD
Provider Second Line Business Practice Location Address:
SUITE 15
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-348-4565
Provider Business Practice Location Address Fax Number:
321-610-5115
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRAY
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
T
Authorized Official Title or Position:
CFO & TREASURER
Authorized Official Telephone Number:
615-345-5550

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000151200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: AH964 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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