1467158964 NPI number — TOTAL VEIN AND SKIN LLC

Table of content: (NPI 1467158964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467158964 NPI number — TOTAL VEIN AND SKIN LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOTAL VEIN AND SKIN 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:
1467158964
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10383 HAGEN RANCH RD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOYNTON BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33437-3782
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-739-5252
Provider Business Mailing Address Fax Number:
561-739-5255

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 S FEDERAL HWY STE 8
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELRAY BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33483-3320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-278-1362
Provider Business Practice Location Address Fax Number:
561-278-4383
Provider Enumeration Date:
02/06/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BERLIN
Authorized Official First Name:
JOSHUA
Authorized Official Middle Name:
MATTHEW
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
561-739-5252

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207ND0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZD0900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 101012803 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".