1720135718 NPI number — SPEECH PATHOLOGY AND EDUCATIONAL CENTER INC

Table of content: (NPI 1720135718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720135718 NPI number — SPEECH PATHOLOGY AND EDUCATIONAL CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPEECH PATHOLOGY AND EDUCATIONAL CENTER 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:
SPEC
Provider Other Organization Name Type Code:
5
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:
1720135718
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8510 SW 8TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33144-4053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-266-5353
Provider Business Mailing Address Fax Number:
305-266-6550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8510 SW 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33144-4053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-266-5353
Provider Business Practice Location Address Fax Number:
305-266-6550
Provider Enumeration Date:
01/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SUAREZ
Authorized Official First Name:
MILDRED
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
305-266-5353

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SA 1502 , 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: 102170 . This is a "AVMED PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 38616 . This is a "NHP PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4279 . This is a "SOUTH CARE PPO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 237488 . This is a "AMERIGROUP PROVIDER NO." identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 810891900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4602011 . This is a "UHC PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 880762100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 880762101 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: S0638 . This is a "BCBS BILLING NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 683277 . This is a "ACN GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2692772001 . This is a "CIGNA HEALTH CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 886038600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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