1114332483 NPI number — E MEDICAL GROUP OF FLORIDA NO. 3, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114332483 NPI number — E MEDICAL GROUP OF FLORIDA NO. 3, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
E MEDICAL GROUP OF FLORIDA NO. 3, LLC
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:
ANGELS CARE HOME HEALTH
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:
1114332483
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2301 FM 1187
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
MANSFIELD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-469-6739
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6225 PRESIDENTIAL CT
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33919-3566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-690-3210
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/25/2014

Additional Information

Authorized Official

Authorized Official Last Name:
EDDINS
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
817-469-6739

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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