1417366253 NPI number — STATUS MED ASSISTANCE, LLC

Table of content: (NPI 1417366253)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417366253 NPI number — STATUS MED ASSISTANCE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STATUS MED ASSISTANCE, 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:
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:
1417366253
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17070 COLLINS AVE
Provider Second Line Business Mailing Address:
257
Provider Business Mailing Address City Name:
SUNNY ISLES BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33160-3635
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-306-0000
Provider Business Mailing Address Fax Number:
305-306-1111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17070 COLLINS AVE
Provider Second Line Business Practice Location Address:
257
Provider Business Practice Location Address City Name:
SUNNY ISLES BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33160-3635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-306-0000
Provider Business Practice Location Address Fax Number:
305-306-1111
Provider Enumeration Date:
08/06/2014

Additional Information

Authorized Official

Authorized Official Last Name:
BUBUCEA
Authorized Official First Name:
MARIANA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-306-0000

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME113594 , 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: 006257100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: GJ2842 . This is a "MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com