1831175553 NPI number — CENTER FOR MEDICINE INC

Table of content: (NPI 1831175553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831175553 NPI number — CENTER FOR MEDICINE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR MEDICINE 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:
1831175553
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6400 MANATEE AVE W
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
BRADENTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34209-2378
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
841-761-8505
Provider Business Mailing Address Fax Number:
941-761-8240

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6400 MANATEE AVE W
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BRADENTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34209-2378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
841-761-8505
Provider Business Practice Location Address Fax Number:
941-761-8240
Provider Enumeration Date:
12/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SHARMA
Authorized Official First Name:
VISHAL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
941-761-8505

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME71428 , 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: 0406170 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 32972 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2594605 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2093901 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 253745100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 120927 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7829784017 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010030000 . 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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