1265593024 NPI number — JUPITER CONCIERGE FAMILY PRACTICE

Table of content: (NPI 1265593024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265593024 NPI number — JUPITER CONCIERGE FAMILY PRACTICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JUPITER CONCIERGE FAMILY PRACTICE
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:
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:
1265593024
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7969
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JUPITER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33468-7969
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-748-2889
Provider Business Mailing Address Fax Number:
561-748-1523

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2141 S ALTERNATE A1A
Provider Second Line Business Practice Location Address:
200
Provider Business Practice Location Address City Name:
JUPITER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33477-4072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-743-0005
Provider Business Practice Location Address Fax Number:
561-743-7623
Provider Enumeration Date:
12/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BARLOW
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT BILLING COMPANY
Authorized Official Telephone Number:
561-748-2889

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  ME076350 , 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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