1760777007 NPI number — SURGICAL STAFFING DEVELOPMENT AND SERVICES, INC.

Table of content: (NPI 1760777007)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760777007 NPI number — SURGICAL STAFFING DEVELOPMENT AND SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGICAL STAFFING DEVELOPMENT AND SERVICES, 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:
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:
1760777007
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4722
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIALEAH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33014-0722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-252-2243
Provider Business Mailing Address Fax Number:
305-362-3989

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7142 LAUREL LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI LAKES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33014-2664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-252-2243
Provider Business Practice Location Address Fax Number:
305-362-3989
Provider Enumeration Date:
06/15/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HERNANDEZ
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
786-252-2243

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X , with the licence number:  PA 9101047 , 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: 011780300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com