1447469739 NPI number — SOUTH FLORIDA MEDICAL CENTERS INC

Table of content: CHELSEA RYEN WITT DPT (NPI 1063133247)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447469739 NPI number — SOUTH FLORIDA MEDICAL CENTERS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH FLORIDA MEDICAL CENTERS 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:
6
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:
1447469739
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
406 US HIGHWAY ONE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33403-3549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-881-3506
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
406 US HIGHWAY ONE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33403-3549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-881-3506
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ADETULA
Authorized Official First Name:
JIMI
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
954-472-2999

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , 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)





Copyright © 2007-2025 www.npivalidator.com