1598054058 NPI number — FLORIDA INSTITUTE OF RESEARCH, MEDICINE, AND SURGERY, P.A.

Table of content: (NPI 1598054058)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598054058 NPI number — FLORIDA INSTITUTE OF RESEARCH, MEDICINE, AND SURGERY, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA INSTITUTE OF RESEARCH, MEDICINE, AND SURGERY, P.A.
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:
1598054058
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
70 W. GORE STREET,
Provider Second Line Business Mailing Address:
SUITE 100 CREDENTIALING DEPARTMENT
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32806-1124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-426-8484
Provider Business Mailing Address Fax Number:
407-447-5229

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
52 WEST GORE STREET
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:
32806-1114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-426-8484
Provider Business Practice Location Address Fax Number:
407-426-8586
Provider Enumeration Date:
04/05/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CECIL
Authorized Official First Name:
LEE
Authorized Official Middle Name:
B
Authorized Official Title or Position:
CREDENTIALS/MNGD CARE COORDINATOR
Authorized Official Telephone Number:
407-426-8484

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  601046 , 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: 260147800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com