1316318363 NPI number — OPTIMUM HEALTHCARE INC.

Table of content: (NPI 1316318363)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316318363 NPI number — OPTIMUM HEALTHCARE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPTIMUM HEALTHCARE 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:
1316318363
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5403 N CHURCH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33614-5611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-506-6000
Provider Business Mailing Address Fax Number:
888-548-0091

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5403 N CHURCH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33614-5611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-506-6000
Provider Business Practice Location Address Fax Number:
888-548-0091
Provider Enumeration Date:
10/16/2015

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
KIRAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
813-506-6000

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , with the licence number:  87098 , 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: 102663900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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