1659527042 NPI number — NOVA SOUTHEASTERN UNIVERSITY, INC

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 1659527042 NPI number — NOVA SOUTHEASTERN UNIVERSITY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NOVA SOUTHEASTERN UNIVERSITY, 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:
1659527042
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3200 S UNIVERSITY DRIVE
Provider Second Line Business Mailing Address:
SANFORD L. ZIFF BLDG. 3RD FLOOR, ROOM 4364-D
Provider Business Mailing Address City Name:
FT. LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33328-2018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-262-4343
Provider Business Mailing Address Fax Number:
954-262-2269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 S ANDREWS AVE
Provider Second Line Business Practice Location Address:
WEST WING 3RD FLOOR
Provider Business Practice Location Address City Name:
FT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33316-2510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-355-5703
Provider Business Practice Location Address Fax Number:
954-355-5490
Provider Enumeration Date:
08/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ESTEVEZ
Authorized Official First Name:
ROSEMERY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIR CONTRACTING AND CREDENTIALING
Authorized Official Telephone Number:
954-262-4343

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 204E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 104693711 . 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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