1740622307 NPI number — METRO TREATMENT OF FLORIDA, LP

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 1740622307 NPI number — METRO TREATMENT OF FLORIDA, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METRO TREATMENT OF FLORIDA, LP
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:
6
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:
1740622307
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 MAITLAND CENTER PARKWAY
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
MAITLAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32751-4174
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-351-7080
Provider Business Mailing Address Fax Number:
407-351-6930

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2770 DAVIS BLVD
Provider Second Line Business Practice Location Address:
SUITE 90
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34104-4371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-280-0487
Provider Business Practice Location Address Fax Number:
239-280-0493
Provider Enumeration Date:
07/24/2013

Additional Information

Authorized Official

Authorized Official Last Name:
JACKSON
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
407-351-7080

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  2011AD121901 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X , with the licence number: PH 26767 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 023037400 . 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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