1598950784 NPI number — FLORIDA BRACING CENTERS INC

Table of content: (NPI 1598950784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598950784 NPI number — FLORIDA BRACING CENTERS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA BRACING CENTERS INC
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:
1598950784
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 SE 17TH ST
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
FT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33316-2547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-525-6700
Provider Business Mailing Address Fax Number:
954-525-4330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
513 MELALEUCA DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARGATE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-917-5655
Provider Business Practice Location Address Fax Number:
954-971-7773
Provider Enumeration Date:
09/11/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MATTERN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
954-917-5655

Provider Taxonomy Codes

  • Taxonomy code: 222Z00000X , with the licence number:  POR65 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 224P00000X , with the licence number: POR65 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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