1073747721 NPI number — LTC HOSPITALISTS INC

Table of content: (NPI 1073747721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073747721 NPI number — LTC HOSPITALISTS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LTC HOSPITALISTS 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:
1073747721
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 636380
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45263-6380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-424-3672
Provider Business Mailing Address Fax Number:
954-377-3042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 E COMMERCIAL BLVD FL 33308
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33308-3744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-771-2300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
UPPAL
Authorized Official First Name:
ROHIT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
800-424-3672

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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