1760676845 NPI number — STEWART MILLER INSTITUTE FOR EXCELLENCE, INC.

Table of content: (NPI 1760676845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760676845 NPI number — STEWART MILLER INSTITUTE FOR EXCELLENCE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEWART MILLER INSTITUTE FOR EXCELLENCE, 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:
1760676845
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
410 BLANDING BLVD STE 9
Provider Second Line Business Mailing Address:
#303
Provider Business Mailing Address City Name:
ORANGE PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32073-5065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-537-3629
Provider Business Mailing Address Fax Number:
904-272-6859

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
151 COLLEGE DR
Provider Second Line Business Practice Location Address:
STE 6
Provider Business Practice Location Address City Name:
ORANGE PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32065-7683
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-537-3629
Provider Business Practice Location Address Fax Number:
904-272-6859
Provider Enumeration Date:
08/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
MYRALYN
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRESIDENT/SPEECH PATHOLOGIST
Authorized Official Telephone Number:
904-276-1212

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SA 893 , 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)





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