1508820671 NPI number — DR. MICHELE RENNA BECK-TORRES MD

Table of content: DR. MICHELE RENNA BECK-TORRES MD (NPI 1508820671)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508820671 NPI number — DR. MICHELE RENNA BECK-TORRES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BECK-TORRES
Provider First Name:
MICHELE
Provider Middle Name:
RENNA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1508820671
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1447 MEDICAL PARK BLVD
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
WELLINGTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33414-3164
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-792-4508
Provider Business Mailing Address Fax Number:
561-964-8961

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1447 MEDICAL PARK BLVD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
WELLINGTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33414-3164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-792-4508
Provider Business Practice Location Address Fax Number:
561-964-8961
Provider Enumeration Date:
04/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME83580 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: ME83580 , 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)

  • Identifier: 2700466720000E . This is a "VISTA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0701884 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 270046672 . This is a "TAX ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 262844900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 270046672 . This is a "HUMANA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 195758 . This is a "STAYWELL/WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: H54674 . This is a "PARITY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2702449 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 62926 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 104603300 . 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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