1881603900 NPI number — PAUL A RODRIGUEZ DO PA

Table of content: (NPI 1881603900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881603900 NPI number — PAUL A RODRIGUEZ DO PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAUL A RODRIGUEZ DO 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:
VIP PAIN MEDICINE LLC
Provider Other Organization Name Type Code:
3
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:
1881603900
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1821 NE 25TH STREET
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
LIGHTHOUSE POINT
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-941-0484
Provider Business Mailing Address Fax Number:
954-941-0485

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1821 NE 25TH ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LIGHTHOUSE POINT
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33064-7744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-941-0484
Provider Business Practice Location Address Fax Number:
954-941-0485
Provider Enumeration Date:
08/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIRECTOR, PRESIDENT,SECRETARY,TREAS
Authorized Official Telephone Number:
954-941-0484

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  OS7048 , 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: 285366 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: DQ2139 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: L4QH7 . This is a "FLORIDA BLUE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 49427 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 257541800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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