1578714739 NPI number — MBT CONSULTANTS PL

Table of content: (NPI 1578714739)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578714739 NPI number — MBT CONSULTANTS PL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MBT CONSULTANTS PL
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:
MBT CONSULTANTS HOME INFUSION PHARMACY
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:
1578714739
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13660 JOG RD
Provider Second Line Business Mailing Address:
SUITE # 6
Provider Business Mailing Address City Name:
DELRAY BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33446-3806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-637-1446
Provider Business Mailing Address Fax Number:
561-637-1448

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13660 JOG RD
Provider Second Line Business Practice Location Address:
SUITE # 6
Provider Business Practice Location Address City Name:
DELRAY BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33446-3806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-637-1446
Provider Business Practice Location Address Fax Number:
561-637-1448
Provider Enumeration Date:
10/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
TINSLEY
Authorized Official First Name:
MARGARETA
Authorized Official Middle Name:
BERNARD
Authorized Official Title or Position:
OWNER/MANAGER
Authorized Official Telephone Number:
561-637-1446

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000139300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03256701 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1326225871 . This is a "OTHER NPI # FOR PHARMACY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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