1649802794 NPI number — INDEPENDENCE CARE OF FLORIDA AT NAPLES, LLC

Table of content: DR. JOHN THOMAS SERBES MCCAIN (NPI 1376036269)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649802794 NPI number — INDEPENDENCE CARE OF FLORIDA AT NAPLES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDEPENDENCE CARE OF FLORIDA AT NAPLES, LLC
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:
1649802794
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
517 W SADDLE RIVER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UPPER SADDLE RIVER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07458-1138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-733-1135
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4851 TAMIAMI TRL N STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34103-3098
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-733-1135
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/06/2020

Additional Information

Authorized Official

Authorized Official Last Name:
VIAR
Authorized Official First Name:
ALLISON
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
917-733-1135

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 116941500 . 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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