1760098354 NPI number — FLORIDA HEALTH CARE PLAN, INC

Table of content: (NPI 1760098354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760098354 NPI number — FLORIDA HEALTH CARE PLAN, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA HEALTH CARE PLAN, 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:
1760098354
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1340 RIDGEWOOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLY HILL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32117-2320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-676-7173
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5151 BABCOCK ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALM BAY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32905-4610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-567-7765
Provider Business Practice Location Address Fax Number:
321-567-7763
Provider Enumeration Date:
09/18/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCHANDEL
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
C
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
386-676-7100

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336M0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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