1134784358 NPI number — OCALA INJURY CENTER INC

Table of content: (NPI 1134784358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134784358 NPI number — OCALA INJURY CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OCALA INJURY CENTER 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:
1134784358
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2440 NE MIAMI GARDENS DR STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33180-2734
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-705-0777
Provider Business Mailing Address Fax Number:
305-705-9978

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3300 SW 34TH AVE STE 132
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34474-4438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-644-7707
Provider Business Practice Location Address Fax Number:
866-499-3741
Provider Enumeration Date:
05/02/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GREAUX
Authorized Official First Name:
BERNARD
Authorized Official Middle Name:
ALEXANDER
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-705-0777

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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