1073812954 NPI number — FLORIDA WOMAN CARE, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073812954 NPI number — FLORIDA WOMAN CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA WOMAN CARE, 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:
1073812954
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4205 W ATLANTIC AVE
Provider Second Line Business Mailing Address:
SUITE C-405
Provider Business Mailing Address City Name:
DELRAY BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33445-3901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-300-2410
Provider Business Mailing Address Fax Number:
561-495-5408

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3113 STIRLING ROAD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
HOLLYWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33312-6547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-447-2704
Provider Business Practice Location Address Fax Number:
954-447-2708
Provider Enumeration Date:
03/18/2011

Additional Information

Authorized Official

Authorized Official Last Name:
KONSKER
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
561-300-2410

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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