1629345681 NPI number — MEDICAL & INJURY CENTERS OF FLORIDA

Table of content: (NPI 1629345681)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629345681 NPI number — MEDICAL & INJURY CENTERS OF FLORIDA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL & INJURY CENTERS OF FLORIDA
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:
1629345681
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 VIRGINIA AVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
HAPEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30354-4302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-938-2625
Provider Business Mailing Address Fax Number:
404-549-3393

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5132 US HIGHWAY 19
Provider Second Line Business Practice Location Address:
21ST CENTURY PAVILLION
Provider Business Practice Location Address City Name:
NEW PORT RICHEY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34652-3942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-807-7932
Provider Business Practice Location Address Fax Number:
727-807-7939
Provider Enumeration Date:
11/18/2011

Additional Information

Authorized Official

Authorized Official Last Name:
KOTHARI
Authorized Official First Name:
SHAILESH
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
770-938-2625

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com