1588768279 NPI number — COUNTY OF DADE BOARD OF COUNTY COMMISSIONERS

Table of content: (NPI 1588768279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588768279 NPI number — COUNTY OF DADE BOARD OF COUNTY COMMISSIONERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF DADE BOARD OF COUNTY COMMISSIONERS
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:
1588768279
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 947330
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30394-7330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-313-6027
Provider Business Mailing Address Fax Number:
877-992-6934

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9300 NW 41ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DORAL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33178-2312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-331-4623
Provider Business Practice Location Address Fax Number:
786-331-4621
Provider Enumeration Date:
09/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REYES
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
ASSISTANT DIRECTOR, ADMINISTRATIVE
Authorized Official Telephone Number:
786-331-5253

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  3375 , 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: 407590188 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 083899301 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: A0508 . This is a "PART B MEDICARE #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 083899301 . 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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