1467558817 NPI number — PRAGER SIMON & ASSOCIATES LLP

Table of content: EVELYN LOUISE BULL (NPI 1962165183)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467558817 NPI number — PRAGER SIMON & ASSOCIATES LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRAGER SIMON & ASSOCIATES LLP
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:
1467558817
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8950 SW 57TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PINECREST
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33156-2133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-322-4116
Provider Business Mailing Address Fax Number:
305-666-2252

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8950 SW 57TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINECREST
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33156-2133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-322-4116
Provider Business Practice Location Address Fax Number:
305-666-2252
Provider Enumeration Date:
09/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PRAGER
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
STEVEN
Authorized Official Title or Position:
MANAGING PARNTER CEO
Authorized Official Telephone Number:
305-322-4116

Provider Taxonomy Codes

  • Taxonomy code: 207RC0200X , with the licence number:  ME 45897 , 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: 281554 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 38190 . This is a "BCBS FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7751301 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 266283300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2662939 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: DA1847 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 266283300 . 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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