1881603645 NPI number — INTEGRATED MEDICAL CENTER OF JUPITER, PA

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 1881603645 NPI number — INTEGRATED MEDICAL CENTER OF JUPITER, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATED MEDICAL CENTER OF JUPITER, PA
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:
1881603645
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
920 W INDIANTOWN RD
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
JUPITER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33458-6847
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-747-7707
Provider Business Mailing Address Fax Number:
561-748-5502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 W INDIANTOWN RD
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
JUPITER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33458-6847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-747-7707
Provider Business Practice Location Address Fax Number:
561-748-5502
Provider Enumeration Date:
08/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BASSETT
Authorized Official First Name:
LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICER
Authorized Official Telephone Number:
561-747-7707

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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