1790122034 NPI number — HARP MEDICAL LLC

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 1790122034 NPI number — HARP MEDICAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARP MEDICAL LLC
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:
1790122034
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1685
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JUPITER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33468-1685
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
564-748-2889
Provider Business Mailing Address Fax Number:
561-748-1523

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2655 N OCEAN DR
Provider Second Line Business Practice Location Address:
103
Provider Business Practice Location Address City Name:
RIVIERA BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33404-4751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-594-0206
Provider Business Practice Location Address Fax Number:
561-512-2873
Provider Enumeration Date:
05/28/2013

Additional Information

Authorized Official

Authorized Official Last Name:
WALDRON
Authorized Official First Name:
SANDY
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING CONTACT
Authorized Official Telephone Number:
561-300-6909

Provider Taxonomy Codes

  • Taxonomy code: 207RA0401X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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