1669817474 NPI number — AMERICAN HEALTH S, LLC

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 1669817474 NPI number — AMERICAN HEALTH S, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN HEALTH S, 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:
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:
1669817474
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15712 SW 41ST ST
Provider Second Line Business Mailing Address:
SUITES 16-20
Provider Business Mailing Address City Name:
DAVIE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33331-1538
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-919-5005
Provider Business Mailing Address Fax Number:
954-919-5042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10270 OLD COLUMBIA RD STE 600
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21046-1867
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-423-0939
Provider Business Practice Location Address Fax Number:
410-381-0102
Provider Enumeration Date:
05/07/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
CHRIS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
954-919-5007

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  1835 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 21D2039533 . This is a "CLIA ID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1835 . This is a "MEDICAL LABORATORY PERMIT" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 421186300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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