1538198783 NPI number — CFA KIDNEY & HYPERTENSION CENTER LLC

Table of content: (NPI 1538198783)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538198783 NPI number — CFA KIDNEY & HYPERTENSION CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CFA KIDNEY & HYPERTENSION CENTER 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:
1538198783
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P O BOX 915467
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONGWOOD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32791-5467
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-214-4133
Provider Business Mailing Address Fax Number:
321-214-4216

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
587 E STATE ROAD 434
Provider Second Line Business Practice Location Address:
SUITE 1011
Provider Business Practice Location Address City Name:
LONGWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32750-5284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-214-4133
Provider Business Practice Location Address Fax Number:
321-214-4216
Provider Enumeration Date:
07/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DARAMOLA-OGUNWUYI
Authorized Official First Name:
OLUFUNMILOLA
Authorized Official Middle Name:
OLUWAKEMI
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
321-214-4133

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  L06000028969 , 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: 14479901 . This is a "CITRUS HEALTH CARE PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7281278 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: DF1497 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 56284 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 276132700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 303267 . This is a "AVMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 354671 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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