1952575953 NPI number — PRO MEDICAL EAST LLC

Table of content: (NPI 1952575953)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952575953 NPI number — PRO MEDICAL EAST LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRO MEDICAL EAST 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:
PROFESSIONAL MEDICAL ENTERPRISES LLC
Provider Other Organization Name Type Code:
5
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:
1952575953
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6555 POWERLINE RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
FORT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33309-2067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-677-1011
Provider Business Mailing Address Fax Number:
954-677-0922

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6555 POWERLINE RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
FORT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33309-2067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-677-1011
Provider Business Practice Location Address Fax Number:
954-677-0922
Provider Enumeration Date:
04/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DIMARCO
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
FRANCIS
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
610-525-3162

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  6000006633 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 408730500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 540H104220 . This is a "MICHIGAN BC/BS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P2723785 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0005164000 . This is a "KEYSTONE EAST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200068890A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 82839600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8704805 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90003799 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: DM1174 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2272955 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000246014 . This is a "HIGHMARK BC/BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4344350 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 625683800 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0005164000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0018611300003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4582539 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com