1619972130 NPI number — TOTAL EMEDICAL INC

Table of content: (NPI 1619972130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619972130 NPI number — TOTAL EMEDICAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOTAL EMEDICAL 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:
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:
1619972130
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 FAIRWAY DR
Provider Second Line Business Mailing Address:
SUITE 208
Provider Business Mailing Address City Name:
DEERFIELD BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33441-1814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-750-5252
Provider Business Mailing Address Fax Number:
561-206-0654

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 FAIRWAY DR
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
DEERFIELD BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33441-1814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-750-5252
Provider Business Practice Location Address Fax Number:
561-206-0654
Provider Enumeration Date:
06/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RUDNICK
Authorized Official First Name:
HOWARD
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
877-750-5252

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  6080132267834 , 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: 200888890A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9061003 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0149462-00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 874939998 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02769813 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 031251700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102226153 0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 718343191A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 159519741 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009934906 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025672800 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1019712 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 371389 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2630755 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 43283500 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 55057861 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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