1548345234 NPI number — MAVERICK MEDICAL VENTURES, INC.

Table of content: (NPI 1548345234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548345234 NPI number — MAVERICK MEDICAL VENTURES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAVERICK MEDICAL VENTURES, 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:
PHYSICIANS CHOICE MRI & IMAGING
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:
1548345234
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3501 CATTLEMEN RD
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
SARASOTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34232-6055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-342-7667
Provider Business Mailing Address Fax Number:
941-342-7847

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3501 CATTLEMEN RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34232-6055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-342-7667
Provider Business Practice Location Address Fax Number:
941-342-7847
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BAFIA
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
941-342-7667

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  HCC5056 , 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: 7180294 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2013853 . This is a "FIRST HEALTH PROVIDER NUM" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 201694 . This is a "STAYWELL PROVIDER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 226521 . This is a "AMERIGROUP PROVIDER NUMBE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: V2973 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 5425850 . This is a "CCN PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 82030 . This is a "MEDICARE COMPLETE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: A2545060 . This is a "OXFORD PROVIDER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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