1538563754 NPI number — SUNFLOWER CONCIERGE MEDICAL SERVICES LLC

Table of content: (NPI 1538563754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538563754 NPI number — SUNFLOWER CONCIERGE MEDICAL SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNFLOWER CONCIERGE MEDICAL 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:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1538563754
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
948 S WICKHAM RD
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
WEST MELBOURNE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32904-1647
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-956-7370
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
948 S WICKHAM RD
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
WEST MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32904-1647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-956-7370
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2014

Additional Information

Authorized Official

Authorized Official Last Name:
PRIYANKA
Authorized Official First Name:
GEETHA
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
321-279-5579

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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