1033374517 NPI number — HOVEROUND CORPORATION

Table of content: (NPI 1033374517)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033374517 NPI number — HOVEROUND CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOVEROUND CORPORATION
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:
1033374517
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6015 31ST ST E STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRADENTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34203-5317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-739-6200
Provider Business Mailing Address Fax Number:
800-337-0424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4913 CHASTAIN AVE
Provider Second Line Business Practice Location Address:
UNIT 33
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28217-2248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-672-9998
Provider Business Practice Location Address Fax Number:
800-337-0424
Provider Enumeration Date:
07/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SUMMERVILLE
Authorized Official First Name:
LAURI
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT AND CFO
Authorized Official Telephone Number:
941-739-6200

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7704975 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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