1497425425 NPI number — ENCORE INFUSION FLORIDA LLC

Table of content: (NPI 1497425425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497425425 NPI number — ENCORE INFUSION FLORIDA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENCORE INFUSION FLORIDA 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:
ENCORE INFUSION
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:
1497425425
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 32789
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALM BEACH GARDENS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33420-2789
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-327-4970
Provider Business Mailing Address Fax Number:
561-823-0829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3555 KRAFT RD UNIT 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34105-5043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-862-4557
Provider Business Practice Location Address Fax Number:
865-862-4556
Provider Enumeration Date:
09/21/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHELTON
Authorized Official First Name:
STACEY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF BUSINESS DEVELOPMENT
Authorized Official Telephone Number:
513-313-9014

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QI0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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