1700017118 NPI number — HIGHLANDS ADVANCED RHEUMATOLOGY AND ARTHRITIS CENTER PL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700017118 NPI number — HIGHLANDS ADVANCED RHEUMATOLOGY AND ARTHRITIS CENTER PL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIGHLANDS ADVANCED RHEUMATOLOGY AND ARTHRITIS CENTER PL
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:
1700017118
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
596 US 27 N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AVON PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33825-2958
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-314-8555
Provider Business Mailing Address Fax Number:
863-314-8505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
596 US 27 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVON PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-314-8555
Provider Business Practice Location Address Fax Number:
863-314-8505
Provider Enumeration Date:
08/03/2009

Additional Information

Authorized Official

Authorized Official Last Name:
TORRES
Authorized Official First Name:
ALEXANDER
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
863-314-8555

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X , with the licence number:  ME105214 , 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: ME105214 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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