1134250509 NPI number — SURGICAL SPECIALIST OF TREASURE COAST PA

Table of content: (NPI 1134250509)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134250509 NPI number — SURGICAL SPECIALIST OF TREASURE COAST PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGICAL SPECIALIST OF TREASURE COAST PA
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:
ROSHAN L H SINGH MD FACS
Provider Other Organization Name Type Code:
5
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:
1134250509
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2215 NEBRASKA AVE
Provider Second Line Business Mailing Address:
SUITE 1A
Provider Business Mailing Address City Name:
FORT PIERCE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34950
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-464-8722
Provider Business Mailing Address Fax Number:
772-464-9978

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2215 NEBRASKA AVE
Provider Second Line Business Practice Location Address:
SUITE 1A
Provider Business Practice Location Address City Name:
FORT PIERCE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-464-8722
Provider Business Practice Location Address Fax Number:
772-464-9978
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SINGH
Authorized Official First Name:
ROSHAN
Authorized Official Middle Name:
L H
Authorized Official Title or Position:
PRESIDENT OF SURGICAL SPECIALISTS
Authorized Official Telephone Number:
772-464-8722

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  ME35626 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 56098 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: F50956260 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 038645800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009747200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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