1528462645 NPI number — FLORIDA HEALTH CARE PLAN, INC

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 1528462645 NPI number — FLORIDA HEALTH CARE PLAN, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA HEALTH CARE PLAN, 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:
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:
1528462645
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2450 MASON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAYTONA BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32114-5110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-615-5008
Provider Business Mailing Address Fax Number:
386-676-7165

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1954 ROCKLEDGE BLVD
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
ROCKLEDGE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32955-3761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-567-7503
Provider Business Practice Location Address Fax Number:
321-567-7504
Provider Enumeration Date:
10/17/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CMO
Authorized Official Telephone Number:
386-615-5008

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336M0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2148449 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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