1639503378 NPI number — MEDICAL CLINICS P.A.

Table of content: (NPI 1639503378)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639503378 NPI number — MEDICAL CLINICS P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL CLINICS 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:
1639503378
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1111 HYPOLUXO RD
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
LANTANA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33462-4271
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-586-3400
Provider Business Mailing Address Fax Number:
561-585-0079

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1880 82ND AVE
Provider Second Line Business Practice Location Address:
SUITE 202E
Provider Business Practice Location Address City Name:
VERO BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32966-6995
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-257-6217
Provider Business Practice Location Address Fax Number:
772-257-6219
Provider Enumeration Date:
08/29/2013

Additional Information

Authorized Official

Authorized Official Last Name:
NEMEROFSKY
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
LOUIS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
561-586-3400

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  ME 19488 , 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)





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