1023096104 NPI number — HOVEROUND CORPORATION

Table of content: (NPI 1023096104)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023096104 NPI number — HOVEROUND CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOVEROUND CORPORATION
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:
1023096104
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6015 31ST ST E STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRADENTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34203-5317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-739-6200
Provider Business Mailing Address Fax Number:
800-337-0424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6015 31ST ST E STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRADENTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34203-5317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-739-6200
Provider Business Practice Location Address Fax Number:
800-337-0424
Provider Enumeration Date:
01/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SUMMERVILLE
Authorized Official First Name:
LAURI
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CFO
Authorized Official Telephone Number:
941-739-6200

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0544007 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 138807741 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 680938300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 98004187 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00723049A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009704830 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200132770A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 806733001 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90562299 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 21490360 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000770716 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004236627 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 343129 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 950568700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1688878 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0701510 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4084608 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 950568700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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