1043591118 NPI number — DR. JAY G. RHODES PA

Table of content: (NPI 1043591118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043591118 NPI number — DR. JAY G. RHODES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. JAY G. RHODES PA
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:
1043591118
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5642 W ATLANTIC BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARGATE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33063-4523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-974-3535
Provider Business Mailing Address Fax Number:
954-971-1081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5642 W ATLANTIC BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARGATE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33063-4523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-974-3535
Provider Business Practice Location Address Fax Number:
954-971-1081
Provider Enumeration Date:
09/02/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RHODES
Authorized Official First Name:
JAY
Authorized Official Middle Name:
GERALD
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
954-974-3535

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  PO0001343 , 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: 054819700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".