1578662227 NPI number — PACE SURGERY CENTER

Table of content: (NPI 1578662227)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578662227 NPI number — PACE SURGERY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACE SURGERY CENTER
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:
1578662227
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3754 HIGHWAY 90
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
PACE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32571-1096
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-994-1883
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3754 HIGHWAY 90
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
PACE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32571-1096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-994-1883
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STOVALL
Authorized Official First Name:
HENRY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
850-416-7681

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , 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: F1482 . This is a "MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 076659300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com