1013097237 NPI number — COMPREHENSIVE BREAST CENTER LIMITED PARTNERSHIP

Table of content: (NPI 1013097237)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013097237 NPI number — COMPREHENSIVE BREAST CENTER LIMITED PARTNERSHIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE BREAST CENTER LIMITED PARTNERSHIP
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:
1013097237
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 160608
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33116-0608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-279-7275
Provider Business Mailing Address Fax Number:
786-219-2908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9090 SW 87TH CT
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33176-2315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-271-8394
Provider Business Practice Location Address Fax Number:
305-675-3627
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GARCIA VILLEGAS
Authorized Official First Name:
ALVARO
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
305-279-7275

Provider Taxonomy Codes

  • Taxonomy code: 261QR0206X , with the licence number:  HCC10405 , 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)

  • Identifier: 004622500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: V3117 . This is a "BC/BS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 010061900 . 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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