1912331240 NPI number — S-H THIRTY-FIVE OPCO - PORT ST. LUCIE, LLC

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 1912331240 NPI number — S-H THIRTY-FIVE OPCO - PORT ST. LUCIE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S-H THIRTY-FIVE OPCO - PORT ST. LUCIE, 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:
Provider Other Organization Name Type Code:
6
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:
1912331240
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 E MARKET ST STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40202-1968
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-779-7663
Provider Business Mailing Address Fax Number:
502-779-4749

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9825 S US HIGHWAY 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT ST LUCIE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34952-5626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-337-0084
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2013

Additional Information

Authorized Official

Authorized Official Last Name:
HUDSON
Authorized Official First Name:
W.
Authorized Official Middle Name:
BRYAN
Authorized Official Title or Position:
S-H THIRTY-FIVE OPCO, LLC BY: ATRIA
Authorized Official Telephone Number:
502-779-4700

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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