1578991857 NPI number — MAR MEDICAL CONSULTANTS, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578991857 NPI number — MAR MEDICAL CONSULTANTS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAR MEDICAL CONSULTANTS, PA
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:
6
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:
1578991857
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
285 SE 5TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELRAY BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33483-5206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-272-8991
Provider Business Mailing Address Fax Number:
561-272-8985

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13660 JOG RD
Provider Second Line Business Practice Location Address:
STE 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:
561-272-8991
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2013

Additional Information

Authorized Official

Authorized Official Last Name:
KUHNS
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
FAYE
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
561-350-6302

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  ME80414 , 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: 003487200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003487201 . 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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