1073601183 NPI number — SKIN CANCER CENTER OF THE TREASURE COAST, INC.

Table of content: (NPI 1073601183)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073601183 NPI number — SKIN CANCER CENTER OF THE TREASURE COAST, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SKIN CANCER CENTER OF THE TREASURE COAST, 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:
1073601183
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:
49 ROYAL PALM PT.
Provider Second Line Business Mailing Address:
SUITE. 100
Provider Business Mailing Address City Name:
VERO BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32960-4295
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-569-5056
Provider Business Mailing Address Fax Number:
772-562-5098

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
49 ROYAL PALM PT.
Provider Second Line Business Practice Location Address:
SUITE. 100
Provider Business Practice Location Address City Name:
VERO BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32960-4295
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-569-5056
Provider Business Practice Location Address Fax Number:
772-562-5098
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOEWINGER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
772-569-5056

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com