1285923482 NPI number — NORTH BEACH VASCULAR & AESTHETICS LLC

Table of content: (NPI 1285923482)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285923482 NPI number — NORTH BEACH VASCULAR & AESTHETICS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH BEACH VASCULAR & AESTHETICS 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:
1285923482
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15400 BISCAYNE BLVD
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
AVENTURA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33160-4614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-957-7277
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15400 BISCAYNE BLVD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
AVENTURA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33160-4614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-957-7277
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2011

Additional Information

Authorized Official

Authorized Official Last Name:
GROPPER
Authorized Official First Name:
ADAM
Authorized Official Middle Name:
Authorized Official Title or Position:
MGR
Authorized Official Telephone Number:
305-957-7277

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME77941 , 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: 010172600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com