1386823060 NPI number — MARIO MARKELIS & STEVEN J. RAPP MDS PA

Table of content: (NPI 1386823060)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386823060 NPI number — MARIO MARKELIS & STEVEN J. RAPP MDS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARIO MARKELIS & STEVEN J. RAPP MDS PA
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:
6
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:
1386823060
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 E. HALLANDALE BEACH BLVD
Provider Second Line Business Mailing Address:
STE #QR
Provider Business Mailing Address City Name:
HALLANDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-456-5533
Provider Business Mailing Address Fax Number:
954-456-6072

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 E. HALLANDALE BEACH BLVD
Provider Second Line Business Practice Location Address:
STE #QR
Provider Business Practice Location Address City Name:
HALLANDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-456-5533
Provider Business Practice Location Address Fax Number:
954-456-6072
Provider Enumeration Date:
10/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RAPP
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
954-456-5533

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0007331008 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 036033300 . This is a "MEDICAID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0402718 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 93406 . This is a "BLUE CROSS BLUE SHIELD FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0402719 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2227668 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 93406U . This is a "PROVIDER'S PIN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0004520509 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0470249 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1408414 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 206931 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 310768 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1036392 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2031MERL . This is a "NEIGHBORHOOD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 036731100 . This is a "MEDICAID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2296549 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7291886 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 94267W . This is a "PROVIDER'S PIN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0470248 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 063856 . This is a "NEIGHBORHOOD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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