1295823540 NPI number — AMERICAN HEALTH S, LLC

Table of content: (NPI 1295823540)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295823540 NPI number — AMERICAN HEALTH S, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN HEALTH S, LLC
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:
1295823540
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15712 SW 41ST ST
Provider Second Line Business Mailing Address:
SUITES 16-20
Provider Business Mailing Address City Name:
DAVIE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33331-1538
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-919-5005
Provider Business Mailing Address Fax Number:
954-919-5042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15712 SW 41ST ST
Provider Second Line Business Practice Location Address:
SUITES 16-20
Provider Business Practice Location Address City Name:
DAVIE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33331-1538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-919-5005
Provider Business Practice Location Address Fax Number:
954-919-5042
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
CHRIS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
954-919-5005

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  800001801 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 291U00000X , with the licence number: 80021538 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 103G69575 . This is a "MEDICARE PTAN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: L00227 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 064538901 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1835 . This is a "MARYLAND STATE LICENSE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: Q347240001 . This is a "MEDICARE PTAN" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 21D2039533 . This is a "MARYLAND CLIA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 240453 . This is a "MARYLAND PTAN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 10D2217743 . This is a "CLIA JACKSONVILLE FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1521799 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 190002129 . This is a "MEDICARE PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 800001801 . This is a "DAVIE, FL. STATE LICENSE NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 10D0707800 . This is a "CLIA ID NUMBER- DAVIE, FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 10D1504277 . This is a "CLIA NO- PINELLAS PARL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 44D2009082 . This is a "CLIA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 800021538 . This is a "STATE LAB LICENSE, PINELL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0000004191 . This is a "LABORATORY LICENSE NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1295823540 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1669817474 . This is a "MARYLAND MEDICAID NPI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 42118 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42D1080642 . This is a "CLIA" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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