1255331187 NPI number — MARTIN COUNTY FLORIDA BOARD OF COMMISSIONERS

Table of content: (NPI 1255331187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255331187 NPI number — MARTIN COUNTY FLORIDA BOARD OF COMMISSIONERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARTIN COUNTY FLORIDA BOARD OF COMMISSIONERS
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:
1255331187
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3485 SE WILLOUGHBY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STUART
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34994-5060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-463-7277
Provider Business Mailing Address Fax Number:
772-419-4544

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 SE MONTEREY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STUART
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34994-4507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-288-5710
Provider Business Practice Location Address Fax Number:
772-288-5942
Provider Enumeration Date:
07/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
LYNN
Authorized Official Middle Name:
Authorized Official Title or Position:
EMS BILLING MANAGER
Authorized Official Telephone Number:
772-463-6277

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  001740 , 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: 590007709 . This is a "MEDICARE METRAHEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1006911 . This is a "MEDICAID/NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 227254 . This is a "BC CAPITAL/778995" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 636574609A . This is a "GEORGIA MCD" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: QAB159 . This is a "MEDICAID SC" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 083903500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1006911 . This is a "NORTH CAROLINA MCD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 229946600 . This is a "US DEPARTMENT OF LABOR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7400743 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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