1255465605 NPI number — FLORIDA HEALTH CARE PLAN INC

Table of content: (NPI 1255465605)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255465605 NPI number — FLORIDA HEALTH CARE PLAN INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA HEALTH CARE PLAN INC
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:
1255465605
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2450 MASON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAYTONA BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32114-5110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-615-5008
Provider Business Mailing Address Fax Number:
386-676-7165

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
937 N SPRING GARDEN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32720-2560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-736-7318
Provider Business Practice Location Address Fax Number:
386-943-8123
Provider Enumeration Date:
03/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
CMO
Authorized Official Telephone Number:
386-615-5008

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336M0003X , with the licence number: PH23786 , 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: 2004146 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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