1679882641 NPI number — A.H. OF MONROE COUNTY, INC.

Table of content: (NPI 1679882641)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679882641 NPI number — A.H. OF MONROE COUNTY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A.H. OF MONROE COUNTY, 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:
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:
1679882641
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4374
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEY WEST
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33041-4374
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-296-6196
Provider Business Mailing Address Fax Number:
305-296-6337

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1434 KENNEDY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEY WEST
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33040-4008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-296-6196
Provider Business Practice Location Address Fax Number:
305-296-6337
Provider Enumeration Date:
09/24/2010

Additional Information

Authorized Official

Authorized Official Last Name:
PRIDGEN
Authorized Official First Name:
EUGENE
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
305-296-6196

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  080850400 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 080850400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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