1568497527 NPI number — THE UNIVERSITY OF CENTRAL FLORIDA BOARD OF TRUSTEES

Table of content: (NPI 1568497527)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568497527 NPI number — THE UNIVERSITY OF CENTRAL FLORIDA BOARD OF TRUSTEES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE UNIVERSITY OF CENTRAL FLORIDA BOARD OF TRUSTEES
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:
COMMUNICATION DISORDERS CLINIC
Provider Other Organization Name Type Code:
5
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:
1568497527
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3280 PROGRESS DR STE 500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32826-2903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-882-0468
Provider Business Mailing Address Fax Number:
407-904-8120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3280 PROGRESS DR STE 500
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32826-2903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-882-0468
Provider Business Practice Location Address Fax Number:
407-904-8120
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KNOX
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
GAIL
Authorized Official Title or Position:
CLINIC DIRECTOR
Authorized Official Telephone Number:
407-882-0468

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SA1747 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SA2208 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X , with the licence number: SA1762 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SA1559 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SA9 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SA3799 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SA6501 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SA7017 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SA5701 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SA5847 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SA5133 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 891708600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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