1053361527 NPI number — COMPREHENSIVE MEDICAL CARE CENTER

Table of content: USHA PRASAD MPH, DO (NPI 1770947236)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053361527 NPI number — COMPREHENSIVE MEDICAL CARE CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE MEDICAL CARE CENTER
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:
1053361527
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 327360
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33332
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-949-6700
Provider Business Mailing Address Fax Number:
305-949-6773

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1380 NE MIAMI GARDENS DR STE 242
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH MIAMI BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33179
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-949-6700
Provider Business Practice Location Address Fax Number:
305-949-6773
Provider Enumeration Date:
05/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VILVAR
Authorized Official First Name:
SERGE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
786-252-2769

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  ME 78304 , 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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