1902069826 NPI number — BVL PEDIATRICS LLC

Table of content: (NPI 1902069826)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902069826 NPI number — BVL PEDIATRICS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BVL PEDIATRICS LLC
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:
BVL PEDIATRICS
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:
1902069826
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2535 BOGGY CREEK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KISSIMMEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34744-3806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-344-0021
Provider Business Mailing Address Fax Number:
407-344-0043

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2535 BOGGY CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KISSIMMEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34744-3806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-344-0021
Provider Business Practice Location Address Fax Number:
407-344-0043
Provider Enumeration Date:
07/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
QURESHI
Authorized Official First Name:
AKBAR
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
407-344-0021

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3791513002 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 117066800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com