1831225580 NPI number — THE MEDITREND GROUP, INC.

Table of content: (NPI 1831225580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831225580 NPI number — THE MEDITREND GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE MEDITREND GROUP, 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:
THE MEDITREND GROUP, INC. - SURGERY CENTER AT WELLINGTON
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:
1831225580
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2030 W MCNAB RD
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
FT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33309-1002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-633-1008
Provider Business Mailing Address Fax Number:
954-633-1024

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1395 S STATE ROAD 7
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
WELLINGTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33414-9325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-633-1008
Provider Business Practice Location Address Fax Number:
954-633-1024
Provider Enumeration Date:
02/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STERN
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
DANIEL
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
954-633-1008

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , 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: 8000119629 . This is a "LABORATORY LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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