1467654053 NPI number — HEALTH VENTURES LLC

Table of content: (NPI 1467654053)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467654053 NPI number — HEALTH VENTURES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH VENTURES 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:
KIDZ AND FAMILY CARE
Provider Other Organization Name Type Code:
3
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:
1467654053
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 150038
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALTAMONTE SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32715-0038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-331-6236
Provider Business Mailing Address Fax Number:
407-331-6953

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
745 ORIENTA AVENUE
Provider Second Line Business Practice Location Address:
STE #1191
Provider Business Practice Location Address City Name:
ALTAMONTE SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-331-6236
Provider Business Practice Location Address Fax Number:
407-331-6953
Provider Enumeration Date:
06/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NIMBARGI
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
PHILIP
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
407-782-3702

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  ME85807 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080A0000X , with the licence number: ME85807 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1852839 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 5324701 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 113345 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 26574200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 62948 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 8665410 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 008675900 . 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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