1235237421 NPI number — NURSECORE MANAGEMENT SERVICES, LLC

Table of content: (NPI 1235237421)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235237421 NPI number — NURSECORE MANAGEMENT SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NURSECORE MANAGEMENT SERVICES, 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:
NURSECORE OF PORT CHARLOTTE
Provider Other Organization Name Type Code:
3
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:
1235237421
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 201925
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76006-1925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-649-1166
Provider Business Mailing Address Fax Number:
817-649-2638

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2811 TAMIAMI TRL STE H
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT CHARLOTTE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33952-5135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-743-8878
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOLLAR
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
817-649-1166

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  207890961 , 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: JF9 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 611276800 . This is a "DEPARTMENT OF LABOR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 682863905 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 118157700 . 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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