1245241603 NPI number — CITY OF CORAL SPRINGS

Table of content: (NPI 1245241603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245241603 NPI number — CITY OF CORAL SPRINGS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF CORAL SPRINGS
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:
1245241603
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 100256
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29202-3256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-612-7638
Provider Business Mailing Address Fax Number:
954-344-5933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4150 NW 120TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORAL SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33065-7622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-612-7638
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BARRY
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIVISION CHIEF
Authorized Official Telephone Number:
954-612-7638

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  3224 , 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: 400039100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: A0698 . This is a "PART B MEDICARE #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 400039100 . 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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