1346213576 NPI number — SPECIALIZED SPEECH CENTER, INC.

Table of content: (NPI 1346213576)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346213576 NPI number — SPECIALIZED SPEECH CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECIALIZED SPEECH CENTER, 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:
1346213576
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3335 N UNIVERSITY DR
Provider Second Line Business Mailing Address:
SUITE 5
Provider Business Mailing Address City Name:
HOLLYWOOD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33024-2200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-442-9422
Provider Business Mailing Address Fax Number:
954-442-9150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3335 N UNIVERSITY DR
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
HOLLYWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33024-2200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-442-9422
Provider Business Practice Location Address Fax Number:
954-442-9150
Provider Enumeration Date:
02/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TAMBASCO
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE-PRESIDENT
Authorized Official Telephone Number:
954-442-9422

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OT11451 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SA4906 , 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: S1795 . This is a "BC/BS OF FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 884449600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 830087900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 883785600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2015424 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 884371600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: T0757 . This is a "BC/BS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 884449600 . 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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