1659628956 NPI number — BROWARD PRIMARY PARTNERS LLC

Table of content: DR. EMILY ANNE DAVIS KINNEY M.D. (NPI 1073856670)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659628956 NPI number — BROWARD PRIMARY PARTNERS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROWARD PRIMARY PARTNERS 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:
1659628956
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 S CENTRAL BLVD
Provider Second Line Business Mailing Address:
SUITE 207
Provider Business Mailing Address City Name:
JUPITER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33458-8812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 S CENTRAL BLVD
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
JUPITER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33458-8812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-745-3877
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/07/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CAMERLINCK
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
MGR MBR
Authorized Official Telephone Number:
561-371-4142

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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