1639245079 NPI number — SUKY HEALTH CARE SERVICES, INC.

Table of content: (NPI 1639245079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639245079 NPI number — SUKY HEALTH CARE SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUKY HEALTH CARE SERVICES, 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:
1639245079
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2350 SW 8TH ST
Provider Second Line Business Mailing Address:
STE 202
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33135-4916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-541-2333
Provider Business Mailing Address Fax Number:
305-541-8920

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2350 SW 8TH ST
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33135-4916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-541-2333
Provider Business Practice Location Address Fax Number:
305-541-8920
Provider Enumeration Date:
11/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
BERTA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
ADMINISTRATOR, CEO
Authorized Official Telephone Number:
305-541-2333

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  S53789 , 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: 6500038205 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6500038279 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6500038296 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6500038202 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6500038203 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6500038298 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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