1184665960 NPI number — MR. EDWARD JOHN SAVINON LHAS

Table of content: MR. EDWARD JOHN SAVINON LHAS (NPI 1184665960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184665960 NPI number — MR. EDWARD JOHN SAVINON LHAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAVINON
Provider First Name:
EDWARD
Provider Middle Name:
JOHN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LHAS
Provider Gender Code:
M

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:
1184665960
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 406153
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-1876
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-478-8770
Provider Business Mailing Address Fax Number:
561-688-8877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
354 N CONGRESS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOYNTON BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33426-3414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-736-8599
Provider Business Practice Location Address Fax Number:
561-743-0195
Provider Enumeration Date:
06/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 237700000X , with the licence number:  AS2184 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 610238700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 112969400 . 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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