1871991240 NPI number — IPERFORMANCE CENTER

Table of content: (NPI 1871991240)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871991240 NPI number — IPERFORMANCE CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IPERFORMANCE CENTER
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:
1871991240
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 CALUSA BLVD
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
DESTIN
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32541-5753
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-460-2024
Provider Business Mailing Address Fax Number:
850-460-7987

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 CALUSA BLVD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
DESTIN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32541-5753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-460-2024
Provider Business Practice Location Address Fax Number:
850-460-7987
Provider Enumeration Date:
12/16/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MARGAGLIANO
Authorized Official First Name:
APRIL
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
850-460-2024

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X , 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: 735439 . This is a "OPTUM HEALTH/UNITEDHEALTHCARE INDIVIDUAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: Y91AW . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 6923846 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 14370 . This is a "OPTUM HEALTH/UNITEDHEALTHCARE GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1871991240 . This is a "TRICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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