1407670425 NPI number — OPTIMAL RESEARCH SITES, LLC

Table of content: (NPI 1407670425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407670425 NPI number — OPTIMAL RESEARCH SITES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPTIMAL RESEARCH SITES, 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:
1407670425
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2541 S VOLUSIA AVE STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGE CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32763-9116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-218-5911
Provider Business Mailing Address Fax Number:
386-406-8365

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2541 S VOLUSIA AVE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32763-9116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-218-5911
Provider Business Practice Location Address Fax Number:
386-406-8365
Provider Enumeration Date:
11/15/2024

Additional Information

Authorized Official

Authorized Official Last Name:
DEL CAMPPO
Authorized Official First Name:
KIMBERLEE
Authorized Official Middle Name:
Authorized Official Title or Position:
MRS.
Authorized Official Telephone Number:
386-218-5911

Provider Taxonomy Codes

  • Taxonomy code: 261QR1100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1053092221 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1285686824 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1881895951 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1548616378 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1366635831 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1679171532 . This is a "FAMILY MEDICINE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1013969898 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1952516742 . This is a "PEDIATRICS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com