1982154944 NPI number — AMERICAN ARTHRITIS & RHEUMATOLOGY ASSOCIATES-PEDIATRICS LLC

Table of content: (NPI 1982154944)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982154944 NPI number — AMERICAN ARTHRITIS & RHEUMATOLOGY ASSOCIATES-PEDIATRICS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN ARTHRITIS & RHEUMATOLOGY ASSOCIATES-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:
FARA
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:
1982154944
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2063
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JUPITER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33468-2063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-766-5187
Provider Business Mailing Address Fax Number:
440-551-4658

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
694 8TH ST N
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34102-5523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-766-5187
Provider Business Practice Location Address Fax Number:
440-551-4658
Provider Enumeration Date:
10/13/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BUSCH
Authorized Official First Name:
HOWARD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
772-766-5187

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X , with the licence number:  ME48624 , 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)





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