1588628796 NPI number — MINIAT WORKS, LLC

Table of content: (NPI 1588628796)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588628796 NPI number — MINIAT WORKS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MINIAT WORKS, LLC
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:
HARBOR MEDICAL CENTER
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:
1588628796
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:
PO BOX 7
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT ST JOE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32457-0007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-653-1212
Provider Business Mailing Address Fax Number:
850-653-4805

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
137 12TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APALACHICOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32320-2110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-653-1212
Provider Business Practice Location Address Fax Number:
850-653-4805
Provider Enumeration Date:
04/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MINIAT
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
850-653-1212

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  01-106 , 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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