1760510648 NPI number — MEDICAL STAFFING NETWORK, INC

Table of content: (NPI 1760510648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760510648 NPI number — MEDICAL STAFFING NETWORK, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL STAFFING NETWORK, 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:
1760510648
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 YAMATO RD STE 901
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33431-4497
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-322-1300
Provider Business Mailing Address Fax Number:
561-322-1445

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3301 NORTHLAND DR
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78731-4939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-459-5656
Provider Business Practice Location Address Fax Number:
512-459-8616
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LITTLE
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
561-322-1300

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  008145 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 112913201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001002296 . This is a "MDCP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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