1730577727 NPI number — GPSC MEDICAL CENTERS LLC

Table of content: (NPI 1730577727)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730577727 NPI number — GPSC MEDICAL CENTERS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GPSC MEDICAL CENTERS 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:
1730577727
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
123 N KROME AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOMESTEAD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33030-6008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-753-6600
Provider Business Mailing Address Fax Number:
786-615-9581

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
123 N KROME AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOMESTEAD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33030-6008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-753-6600
Provider Business Practice Location Address Fax Number:
786-615-9581
Provider Enumeration Date:
12/29/2014

Additional Information

Authorized Official

Authorized Official Last Name:
CADET
Authorized Official First Name:
JULES
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-753-6600

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X , with the licence number:  ME 41852 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X , with the licence number: ME 27293 , 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: 92970 . This is a "MEDICARE IDENTIFICATION NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 96208 . This is a "MEDICARE IDENTIFICATION NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 037315000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 067559801 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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