1578956744 NPI number — EAST COAST HOSPITALIST PHYSICIANS LLP

Table of content: DR. GARLAND KEVIN DAVIS D.D.S. (NPI 1013083252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578956744 NPI number — EAST COAST HOSPITALIST PHYSICIANS LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST COAST HOSPITALIST PHYSICIANS LLP
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:
1578956744
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 REMIT DR # 1367
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60675-1367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-332-4499
Provider Business Mailing Address Fax Number:
231-932-4133

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 NW 12TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33136-1003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-325-5511
Provider Business Practice Location Address Fax Number:
305-325-4673
Provider Enumeration Date:
03/12/2015

Additional Information

Authorized Official

Authorized Official Last Name:
KING
Authorized Official First Name:
DERIK
Authorized Official Middle Name:
K
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
800-701-3381

Provider Taxonomy Codes

  • Taxonomy code: 208M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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