1346961000 NPI number — DEVEREUX FOUNDATION, INC.

Table of content: JOSEPH EMANUEL CANTERINO M.D. (NPI 1447493960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346961000 NPI number — DEVEREUX FOUNDATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEVEREUX FOUNDATION, 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:
1346961000
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5850 T G LEE BLVD STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32822-4409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-362-9234
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8550 ULMERTON RD STE 130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LARGO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33771-5360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-460-4451
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/09/2022

Additional Information

Authorized Official

Authorized Official Last Name:
MCKEEVER
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF ACCOUNTS RECEIVABLE
Authorized Official Telephone Number:
610-542-3064

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 029573658 . 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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