1578042610 NPI number — CMP MEDICAL CENTER CORP.

Table of content: (NPI 1578042610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578042610 NPI number — CMP MEDICAL CENTER CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CMP MEDICAL CENTER CORP.
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:
1578042610
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10021 SW 40TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33165-3945
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-464-0673
Provider Business Mailing Address Fax Number:
786-464-0635

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1797 CORAL WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33145-2728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-464-0673
Provider Business Practice Location Address Fax Number:
786-464-0635
Provider Enumeration Date:
08/09/2018

Additional Information

Authorized Official

Authorized Official Last Name:
CAMBER
Authorized Official First Name:
CELIDA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT / OWNER
Authorized Official Telephone Number:
786-464-0673

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 102561500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com