1205882867 NPI number — HEM ONC ASSOCIATES OF THE TREASURE COAST, PA

Table of content: (NPI 1205882867)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205882867 NPI number — HEM ONC ASSOCIATES OF THE TREASURE COAST, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEM ONC ASSOCIATES OF THE 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:
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:
1205882867
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1871 S.E. TIFFANY AVENUE
Provider Second Line Business Mailing Address:
SUITE #100
Provider Business Mailing Address City Name:
PORT ST LUCIE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34952-7596
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-335-5666
Provider Business Mailing Address Fax Number:
772-335-3781

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1871 S.E. TIFFANY AVENUE
Provider Second Line Business Practice Location Address:
SUITE #100
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:
34952-7596
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-335-5666
Provider Business Practice Location Address Fax Number:
772-335-3781
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
IANNOTTI
Authorized Official First Name:
NICHOLAS
Authorized Official Middle Name:
O
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
772-335-5666

Provider Taxonomy Codes

  • Taxonomy code: 207RX0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 251297100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 40806 . This is a "MEDICARE PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 40806 . This is a "BS/FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 251297100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com