1205062163 NPI number — OUTCOME BASED DELIVERY SYSTEMS ACQUISITION COMPANY, 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 1205062163 NPI number — OUTCOME BASED DELIVERY SYSTEMS ACQUISITION COMPANY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OUTCOME BASED DELIVERY SYSTEMS ACQUISITION COMPANY, 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:
Provider Other Organization Name Type Code:
6
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:
1205062163
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2929 N UNIVERSITY DR
Provider Second Line Business Mailing Address:
SUITE # 110
Provider Business Mailing Address City Name:
CORAL SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33065-5081
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-656-8855
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1120 CITRUS TOWER BLVD
Provider Second Line Business Practice Location Address:
SUITE # 300
Provider Business Practice Location Address City Name:
CLERMONT
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34711-1909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-243-0206
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BRUTEN
Authorized Official First Name:
PATEESHA
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANGER
Authorized Official Telephone Number:
954-656-8855

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  ME103291 , 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)





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