1487789038 NPI number — SOUTH FLORIDA COMMUNITY COLLEGE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487789038 NPI number — SOUTH FLORIDA COMMUNITY COLLEGE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH FLORIDA COMMUNITY COLLEGE
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:
1487789038
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 W COLLEGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AVON PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33825-9356
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-784-7123
Provider Business Mailing Address Fax Number:
863-453-6656

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 W COLLEGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVON PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33825-9348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-784-7123
Provider Business Practice Location Address Fax Number:
863-453-6656
Provider Enumeration Date:
02/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KOVACS
Authorized Official First Name:
ANITA
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
863-784-7123

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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