1710162912 NPI number — CUSTOM MEDICAL SYSTEMS, INC.

Table of content: (NPI 1710162912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710162912 NPI number — CUSTOM MEDICAL SYSTEMS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CUSTOM MEDICAL SYSTEMS, 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:
1710162912
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
404 10TH AVE W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALMETTO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34221-5032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-722-3434
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
404 10TH AVE W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALMETTO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34221-5032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-722-3434
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LOVESKY
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
OWNER/MGR
Authorized Official Telephone Number:
941-722-3434

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , with the licence number:  542 , 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: 671444798 . This is a "HOME & COMM. BASE WAIVER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 686838079 . This is a "BRAIN & SPINAL WAIVER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 671444796 . This is a "DEVELOPMT DISAB WAIVER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 686628000 . This is a "AGE & DIS PERSON WAIVER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 028786500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 016687300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com