1497707962 NPI number — VITAS HEALTHCARE CORPORATION OF FLORIDA

Table of content: (NPI 1497707962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497707962 NPI number — VITAS HEALTHCARE CORPORATION OF FLORIDA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VITAS HEALTHCARE CORPORATION OF FLORIDA
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:
1497707962
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3046 CORPORATE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIRAMAR
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33025-6547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-374-4143
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1435 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOTHAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36301-1311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-350-4143
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WESTFALL
Authorized Official First Name:
NICHOLAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT &CEO
Authorized Official Telephone Number:
513-618-2240

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  E03503 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 592208300-008 . This is a "TRICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: PIC1577E , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 012-265 . This is a "BCBS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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