1528109485 NPI number — CCI BILLING SERVICES LLC

Table of content: (NPI 1528109485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528109485 NPI number — CCI BILLING SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CCI BILLING SERVICES 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:
1528109485
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
92 E MCNAB RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POMPANO BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33060-9238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-545-0337
Provider Business Mailing Address Fax Number:
954-545-3497

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 LEE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEHIGH ACRES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33936-4835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-368-4517
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TRENTHAM
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
954-545-0337

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 278080100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 612438900 . This is a "WORKMANS COMP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: DG2104 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 99300 . This is a "BLUE CROSS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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