1316132772 NPI number — SMA HEALTHCARE INC

Table of content: (NPI 1316132772)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316132772 NPI number — SMA HEALTHCARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SMA HEALTHCARE 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:
ACT CORPORATION
Provider Other Organization Name Type Code:
4
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:
1316132772
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 MAGNOLIA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAYTONA BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32114-4304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-236-3200
Provider Business Mailing Address Fax Number:
386-236-3178

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 FENTRESS BLVD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTONA BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32114-1203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-236-3221
Provider Business Practice Location Address Fax Number:
386-258-4507
Provider Enumeration Date:
09/10/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COSIMI
Authorized Official First Name:
IVAN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
386-236-1811

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 060311298 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060311215 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060311296 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".