1427370436 NPI number — AIRPORT MD-MIAMI LLC

Table of content: (NPI 1427370436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427370436 NPI number — AIRPORT MD-MIAMI LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AIRPORT MD-MIAMI 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:
1427370436
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5741 SOUTHLAND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36693-3307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-700-0278
Provider Business Mailing Address Fax Number:
251-666-8398

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4200 NW 21ST STREET
Provider Second Line Business Practice Location Address:
MIAMI INTERNATIONAL AIRPORT-CONCOURSE H
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-869-4075
Provider Business Practice Location Address Fax Number:
305-869-4076
Provider Enumeration Date:
02/17/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PATRICK
Authorized Official First Name:
RACHEL
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF CREDENTIALING
Authorized Official Telephone Number:
251-602-6996

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , with the licence number:  23-8015240864-1 , 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)