1710931522 NPI number — KENDALL HEALTHCARE GROUP, LTD.

Table of content: (NPI 1710931522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710931522 NPI number — KENDALL HEALTHCARE GROUP, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENDALL HEALTHCARE GROUP, LTD.
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:
1710931522
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11750 BIRD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33175-3530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-223-3000
Provider Business Mailing Address Fax Number:
305-229-2444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11750 BIRD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33175-3530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-223-3000
Provider Business Practice Location Address Fax Number:
305-229-2444
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
READ
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
786-315-5979

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 20860 . This is a "WELLCARE/STAYWELL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 012013800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01557280 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000035941 . This is a "HUMANA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0064596 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 274 . This is a "BLUE CROSS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 012013800 . 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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