1184681330 NPI number — DRS BERGHASH & LANZA PL

Table of content: (NPI 1184681330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184681330 NPI number — DRS BERGHASH & LANZA PL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRS BERGHASH & LANZA PL
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:
1184681330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1801 SE HILLMOOR DR
Provider Second Line Business Mailing Address:
SUITE B105
Provider Business Mailing Address City Name:
PORT ST LUCIE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34952-7545
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-398-9911
Provider Business Mailing Address Fax Number:
772-398-4374

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 SE HILLMOOR DR
Provider Second Line Business Practice Location Address:
SUITE B105
Provider Business Practice Location Address City Name:
PORT ST LUCIE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34952-7545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-398-9911
Provider Business Practice Location Address Fax Number:
772-398-4374
Provider Enumeration Date:
04/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
BETH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
772-979-4035

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CH6061 . This is a "RR MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com