1093057986 NPI number — 3XS PLLC

Table of content: (NPI 1093057986)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093057986 NPI number — 3XS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
3XS PLLC
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:
ST MINA PRIMARY CLINIC
Provider Other Organization Name Type Code:
3
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:
1093057986
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14391 SPRING HILL DR
Provider Second Line Business Mailing Address:
SUITE 444
Provider Business Mailing Address City Name:
SPRING HILL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34609-8199
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-796-5102
Provider Business Mailing Address Fax Number:
352-796-2144

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17222 HOSPITAL BLVD
Provider Second Line Business Practice Location Address:
SUITE 242
Provider Business Practice Location Address City Name:
BROOKSVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34601-8925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-796-5102
Provider Business Practice Location Address Fax Number:
352-796-2144
Provider Enumeration Date:
03/19/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BOLIS
Authorized Official First Name:
LAWANDY
Authorized Official Middle Name:
FAWZY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
352-796-5102

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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