1447491402 NPI number — FELCAS HEALTH CENTER INC

Table of content: (NPI 1447491402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447491402 NPI number — FELCAS HEALTH CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FELCAS HEALTH CENTER 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:
1447491402
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10661 N KENDALL DR
Provider Second Line Business Mailing Address:
112
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33176-8709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-598-6224
Provider Business Mailing Address Fax Number:
305-598-6339

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10661 N KENDALL DR
Provider Second Line Business Practice Location Address:
112
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33176-8709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-598-6224
Provider Business Practice Location Address Fax Number:
305-598-6339
Provider Enumeration Date:
03/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-598-6224

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  ME106122 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: PO2683 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: ME81313 , 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: 001426800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0003E . This is a "BCBSFL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1024561 . This is a "JMH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 3052273 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4752389 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 001426800 . 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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