1265612709 NPI number — TODD D THOMASON NPC INC

Table of content: (NPI 1265612709)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265612709 NPI number — TODD D THOMASON NPC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TODD D THOMASON NPC 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:
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:
1265612709
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 841423
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEMBROKE PINES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33084-1423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-962-9428
Provider Business Mailing Address Fax Number:
954-962-9429

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2350 N UNIVERSITY DR UNIT 841423
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEMBROKE PINES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33084-4106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-962-9428
Provider Business Practice Location Address Fax Number:
954-962-9429
Provider Enumeration Date:
11/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
THOMASON
Authorized Official First Name:
TODD
Authorized Official Middle Name:
DANIEL
Authorized Official Title or Position:
APRN
Authorized Official Telephone Number:
954-227-8224

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  RN9176643 , 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: 114187000 . 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