1609150846 NPI number — OPEN SYSTEMS HEALTHCARE, INC.

Table of content: (NPI 1609150846)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609150846 NPI number — OPEN SYSTEMS HEALTHCARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPEN SYSTEMS HEALTHCARE, 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:
1609150846
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3333 S CONGRESS AVE STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELRAY BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33445-7300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-274-4149
Provider Business Mailing Address Fax Number:
561-450-1443

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1818 MARKET ST
Provider Second Line Business Practice Location Address:
SUITE 2510
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19103-3638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-399-0598
Provider Business Practice Location Address Fax Number:
215-567-2482
Provider Enumeration Date:
10/06/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HUNTER
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
MICHELLE
Authorized Official Title or Position:
DIRECTOR OF CONTRACT DEVELOPMENT
Authorized Official Telephone Number:
727-888-2844

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 299994431 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 015611000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 027477421 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 067990321 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 299994431 . This is a "AHCA LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 015611000 . 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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