1952619728 NPI number — NEMESIS MEDICAL GROUP INC

Table of content: MR. PHILLIP SCOTT ROSS P.T. (NPI 1205871464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952619728 NPI number — NEMESIS MEDICAL GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEMESIS MEDICAL GROUP INC
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:
1952619728
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
782 NW 42ND AVE
Provider Second Line Business Mailing Address:
SUITE 639
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33126-5541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-476-8233
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
782 NW 42ND AVE
Provider Second Line Business Practice Location Address:
SUITE 639
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33126-5541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-476-8233
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
PALACIOS
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-476-8233

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: 022438800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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