1538455621 NPI number — SOUTH FLORIDA PSYCHIATRIC SOLUTIONS, INC.

Table of content: DR. HEATHER LEE WILSON DPM (NPI 1689899981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538455621 NPI number — SOUTH FLORIDA PSYCHIATRIC SOLUTIONS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH FLORIDA PSYCHIATRIC SOLUTIONS, 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:
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:
1538455621
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4159
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIALEAH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33014-0159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-546-5711
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1881 NE 26TH ST
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
WILTON MANORS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33305-1416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-546-5711
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALEZ
Authorized Official First Name:
MERCY
Authorized Official Middle Name:
MARY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
786-546-5711

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  ME77453 , 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)





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