1679584973 NPI number — CITY OF LIGHTHOUSE POINT

Table of content: (NPI 1679584973)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679584973 NPI number — CITY OF LIGHTHOUSE POINT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF LIGHTHOUSE POINT
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:
CITY OF LIGHTHOUSE POINT FIRE
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:
1679584973
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 862434
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32886-2434
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2101 NE 36TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIGHTHOUSE POINT
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33064-7539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-943-7750
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEECH
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
954-941-2624

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  3327 , 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: 400058700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590013685 . This is a "RAILROAD PROVIDER ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 117949700 . 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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